STAYING AWARE

JANET DARNELL WAS PROUD TO GET HER FIRST MAMMOGRAM. A 44-year-old single mother with a cleaning company, she'd managed to save enough money to pay for a reduced-cost breast screening offered in October in recognition of Breast Cancer Awareness Month.

She wasn't prepared for a breast cancer diagnosis.

"The radiologist called me into the office," Ms. Darnell recalled. "They saw something suspicious, a cluster of 12 tiny dots the size of salt and wanted to do a needle biopsy. My first thought was 'How much is this going to cost?' Then I told them, 'Oh well, I don't have health insurance.' The tech put her arm around me and told me I needed the biopsy and there was help through a nonprofit called Partners for Breast Cancer Care."

The organization not only covered the biopsy, it also paid for six weeks of radiation therapy and a lumpectomy.

Twenty-three years later, Ms. Darnell is the executive director of the organization that literally saved her life.

A small nonprofit subsisting mostly on community support through grants, donations and fundraisers, Partners has made a big difference for Lee County's uninsured since its founding in 1990. Last year it provided 371 mammograms to qualifying clients and paid all follow up treatments for the 15 diagnosed with breast cancer, at no cost to the patients.

Partnerships with local health care providers have been fundamental to the nonprofit's mission. Radiologists, surgeons, anesthesiologists, pathologists, oncologists and hospitals provide care at significantly discounted rates. Specialists donated nearly $2.3 million in services last year; the nonprofit paid the remaining $95,951.

Their fees, said Ms. Darnell, haven't changed in 32 years and cover the entire realm of care, from mammograms, MRIs and mastectomies to radiation therapy and chemotherapy.

"We're now funding EKGs, PET and CT scans in our mission to rule out or diagnose breast cancer for someone who can't afford it," she said. "We will carry you all the way through."

Partners for Breast Cancer Care started as a grassroots campaign funded by a 1990 University of Vermont grant (a professor was a part-time Fort Myers resident). It was part of an overarching national initiative established by Congress to provide free breast cancer screenings after research showed a disproportionate breast cancer mortality rate in poor and rural neighborhoods, the population least likely to |get a mammogram.

Mammography is the most effective tool for early detection, identifying breast cancer years before the onset of physical symptoms. Cancer caught in its early stages has a 98 percent survival rate.

"The grant covered the costs for women who couldn't afford a mammo because they didn't have health insurance and had a family to support," said Ms. Darnell. "Women usually put themselves last in the family."

Partners' earliest volunteers knocked on doors in underserved communities throughout, Lee County, encouraging women to get a free mammography. As the number of screenings increased, so did the need for additional testing and treatment not covered by the grant.

"We knew we had a problem but there was nowhere to turn," Ms. Darnell said. "There had to be a second step."

The answer was those invaluable medical partners, the same specialists who treat patients with insurance coverage.

At today's costs — $495 for a mammogram, $1,587 for a breast ultrasound, another $6,000 for an MRI and $10,000 for a needle biopsy — reaching a breast cancer diagnosis rings up to $18,000 before treatment starts. A single chemotherapy treatment can cost $95,000.

"Cost should not be a barrier to any woman in Florida receiving her mammogram," said Tammy Soliz, public information officer for the Florida Department of Health in Lee County which provides free mammograms for women 50 to 64 through the Florida Breast and Cervical Cancer Early Detection Program, also the result of Congress' 1990 Breast and Cervical Cancer Mortality Prevention Act. "The program is for individuals that do not have insurance and may otherwise not receive breast cancer screenings. DOH Lee targets underserved populations which include individuals with low socioeconomic status, rural areas and areas that are experiencing larger numbers of late-stage breast cancer diagnoses."

The county department helps women with abnormal exams navigate their next choices, whether they qualify for state Medicaid which covers treatment costs or if help is available from one of its many supporting groups, including national and state nonprofits and various sororities.

"Partners for Breast Cancer Care partners with DOH Lee to pay for breast MRIs and breast biopsies for our documented FBCCEDPP clients," Ms. Soliz said. "This partnership helps us to cover even more uninsured women's screenings."

Although Partners for Breast Cancer Care doesn't have a steady revenue stream or government funding, it's never turned anyone away, always managing to cover its share of patient costs. It even expanded in 2018 to Collier, Charlotte, Hendry and Glades counties.

"We're spreading out wings and gaining partners," said Ms. Darnell,

Grants from the United Way and support from the community represent a cross-section of its Southwest Florida partners who host private and public fundraisers, including golf tournaments, June's Pink Night sponsored by the Fort Myers Mighty Mussels and an annual November wine dinner hosted by the Kelly Greens community. The Cancer Alliance of Naples helps with rent for Partners' office at Hope Hospice in HealthPark. Ms. Darnell and a case manager are its only employees.

Partners also offers two yearly fundraisers — a February lunch and fashion show and its signature Human Pink Ribbon, postponed since Covid and expected to return in October 2023. This year's October-long event at Coconut Point aims to turn the shopping center pink. Shoppers can purchase the nonprofit's pink umbrellas for $20 at participating stores. The umbrellas will be displayed in storefronts throughout October.

Coconut Point is hosting Sip & Stroll for a Cause Saturday, Oct. 22, from 6 to 8 p.m. The event will feature pink drinks and fashion demonstrations. Participating stores are donating proceeds to Partners.

Ms. Darnell knows all too well the power of community support and how just one caring person like a mammogram technician can make a difference. All she had to do was ask.

"Reaching out to Partners for Breast Cancer Care 23 years ago was the first time I asked for help," she said. "So many people who call us are asking for help for the first time in their lives."

Determining eligibility

Partners for Breast Cancer Care offers no-cost care to clients who live in Southwest Florida, are uninsured and have an annual income of $54,360 for a single household, $111,000 for a family of four in 2022. Clients must provide a Social Security or individual tax identification number, photo ID and a doctor's prescription for breast care.

Florida Breast and Cervical Cancer Early Detection Program is available through the Lee Department of Health to uninsured women 50 to 64 with an annual income 200 percent below the federal poverty rate — $27,180 for a single person household and $55,500 for a family of four. The program also offers mammograms to women 40 to 49 with a first-degree relative diagnosed with breast cancer. ¦

In the KNOW

Risk Factors

Age: Women 50 and older account for most breast cancers

Family history of breast or ovarian cancer

Inherited changes in breast cancer genes BRCA 1 and BRCA 2

Dense breasts

The onset of menstruation before 12 and menopause after 55

A previous breast cancer diagnosis

Radiation therapy before age 30

Exposure to diethylstilbestrol, a drug used between 1940 and 1971 to prevent miscarriage

Certain oral contraceptives and hormone replacement therapy during menopause

Alcohol

Pregnancy after 30, not breastfeeding or never having a full-term pregnancy

Obesity after menopause

Physically inactive

Sources: American Cancer Society, Centers for Disease Control and Prevention, Florida Department of Health, Lee Health, National Institutes of Health National Cancer Institute

Breast Cancer Resources

Partners for Breast Cancer Care, Fort Myers, 239-454-8533, pfbcc.org

Cancer Alliance of Naples, Bonita Springs, 239-643-4673, cancerallianceofnaples.com

Family Health Centers of Southwest Florida, 844- 342-7935, fhcswf.org Locations in Fort Myers, downtown, Estero and Lehigh Acres

The Florida Breast and Cervical Cancer Early Detection Program, administered by The Florida Department of Health in Lee County, 239-332-9535

Lee Health Breast Health Centers Coconut Point, Bonita Springs, 239-468-0055 HealthPark Commons, Fort Myers, 239-343-7264 The Sanctuary, Fort Myers, 239-343-9450 Surfside, Cape Coral, 239- 541-7540

Lee Mammogram Fund at Lee Health provides financial assistance for diagnostic mammograms, breast biopsies and breast MRIs

Sharon MacDonald Breast Health Fund through Lee Health assists with labs, testing, oncology visits and breast surgery for underinsured and uninured patients with a household income below 400 percent of the federal poverty level

WeCare, 239-433-2000

Network of medical providers through the United Way of Lee, Hendry and Glades

U.S.

Although breast cancer predominantly affects women, with 264,000 new cases annually, men account for about 1%, or 2,710, of newly diagnosed cases of invasive breast cancer.

Breast cancer is the second most common cause of cancer deaths in women.

Black women have a higher breast cancer mortality rate than White women.

12.9% of women born today will develop breast cancer during their lives.