Breaking through the 'barriers to care' Advocate helps breast cancer patient face uncertain diagnosis

A lack of health insurance and a lump in Erika Cervantes Diaz's left breast sent her running to the city of Zamora in Michoacán, Mexico, for help in 2021.

The Round Lake resident first went to get the lump checked by an Illinois doctor, only to have him say the lump was "irregular." The specialist told Diaz in person that there was a 50% probability that it was malignant. But a letter from him soon followed saying there was a possibility that it was benign and to wait six months for another look. The mixed messages had Diaz scared.

"Why is it that he changed his opinion?" Diaz, 39, said through an interpreter. "I was not calm."

According to the American Cancer Society, breast cancer is the leading cause of cancer death among Hispanic women in the U.S. The disease is also more often diagnosed at a younger age and at more advanced stages for Hispanic women. And Hispanic women in the U.S. are about 30% more likely to die from their breast cancer than white women, per the Breast Cancer Research Foundation.

"It has been seen that Hispanic women are less updated in mammograms in comparison to other ethnicities," said Dr. Roberto Carlos Montoya Barraza, oncologist at Advocate Good Shepherd Hospital in Barrington. "What was the reason? Many times it has been found that it's cultural. Other reasons are more difficult to tackle, like financial reasons, health disparities that are there, language barrier. There are multiple factors for sure, but those kinds of things contribute."

Diaz talked to her husband, Salvador Fernandez, and told him she wanted to go back home to Mexico to get a biopsy. She ventured south to find out if the lump was malignant; her cancer was estrogen progesterone positive. Waiting was out of the question. The couple decided she would seek treatment there.

"It was very difficult," she said. "I was very scared if I was with the right doctors. But I found a doctor that helped me, and the doctor gave me two options - keep your breast or remove your breast. (The cancer) was level one but I decided to remove it. I had my surgery, a cycle for chemotherapy and a cycle of 15 radiations."

The mastectomy took place in May 2021. But Diaz's follow-up care weighed on her. Not wanting to make the trek back to Mexico every few months, Diaz came back to Round Lake looking for help. Diaz reached out to Mano A Mano Family Resource Center, a nonprofit that helps immigrants integrate into the United States with services that include health care.

In October 2021, the organization gave her Viv Lafin's number. Lafin is a Hispanic health lay navigator with Good Shepherd Hospital and a member of the hospital's Hispanic Breast Care Center, a program that began in 2019, said Rafael Malpica, Good Shepherd's director of hospital programs, community and government relations. Malpica said the hospital created the program for community outreach and education in the hopes of compelling more Latinas to have mammograms and ultrasounds.

"September 2021 to September 2022, we had a 19% increase in the number of Latinas that got screenings here at Good Shepherd," Malpica said. "Part of the education that we're getting out there is getting your screening at the appropriate time. We've been working with churches, schools, places of work, trusted organizations like Mano A Mano to get the word out that this is an issue that you should be looking into."

Lafin connected Diaz with hospital advocates and navigators who assisted her with financial, transportation and language concerns, as well as establishing care with Montoya.

The breast cancer center team walked Diaz through her follow-up care locally, including covering the cost of Diaz's once-a-month endocrine therapy injections and coaching Diaz on how to use the hospital's courtesy van to get to and from doctor appointments with her now 4-year-old daughter, Julieta, in hand.

Lafin even helped Fernandez get a job in Good Shepherd's environmental services and maintenance department to get insurance coverage for his family. The team also helped Diaz sign up her daughter for preschool.

"My role as a navigator is barriers to care," said Donna Smaga, the oncology nurse navigator with Good Shepherd.

"When you don't speak English, that's barrier No. 1. Another is when you don't have insurance. How are you going to pay for your care? Sometimes you have to involve other people in that. A huge barrier to care right now for many cancer patients is reliable transportation. Fortunately, she lived in the area where we could use the courtesy van. That's what navigation is: finding those barriers and getting (patients) where they need to go."

After working with Good Shepherd's staff for the past year, Diaz is cancer free. Smaga commended Diaz for her strength to advocate for herself, and said it's something more people need to do.

Lafin said she often sits with women while they get biopsies, holding their hand, talking to them, interpreting and distracting them while it's being done. Malpica said the breast cancer care team's efforts to build relationships with trusted partners within the Hispanic community has also built trust with patients and families who are now coming to Good Shepherd.

Montoya, a native of Peru, said in other parts of the world, breast cancer incidences are among the top 10 health concerns for Latinas, whereas it is the No. 1 health concern for Latinas in the United States.

"The people from Hispanic ethnicity that are born here, their incidence increases in comparison to immigrants who just come from here," he said. He said there are many variables that factor into that.

"We are doing this program here precisely to raise awareness that there is a way to prevent breast cancer," Montoya said. "We let them know and bring the health service to them."

Diaz thanks God for the Good Shepherd breast cancer care team.

"I felt like God helped me a lot because I called and talked to Viv and she answered me very fast. I was desperate, worried and she was very nice to me. She said, 'Don't worry, we're going to help you.' I was very happy because I can finish my treatment here."

drockett@ chicagotribune.com