A Patient Navigator’s Support for the New York State Breast Cancer Initiative’s 4-Hour Leave for Breast Cancer Screening

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Breast cancer is the most common cancer among women in New York State,[1] and mammography has been shown to be effective at detecting tumors at earlier stages of development than clinical breast exam.[2]

breastcancer_stat_paperworkSource: https://www.ny.gov/programs/new-york-state-breast-cancer-programs

 

All eligible New York State public employees are currently entitled to one annual 4-hour leave from work in order to undergo mammography for early detection of breast cancer. Governor Cuomo wants to expand this policy to cover the private sector, so that all New Yorkers will have the right to life-saving screening without putting their employment status in jeopardy.

As a patient navigator in a cancer center in East Harlem, I believe that this policy will be instrumental in saving lives. Many of the patients we see would be classified as “working poor” – despite often holding two jobs and working constantly, they still live in a state of poverty. Even one day’s lost wages could upset the extremely delicate balance they live and cast them into a state of catastrophe. As a result, many people will often choose the work they need to put food on the table over getting a screening that has little apparent immediate benefit. Unfortunately, this often results in the women who do develop breast cancer only finding out they have the disease at a later stage, making it much more difficult to treat.

Numerous private sector businesses, including M&T Bank and Amneal Pharmaceuticals, have indicated their support for the policy. This is not to say that everyone is on board – there are those organizations[3] who believe that even the state employees’ guaranteed leave for screening is s superfluous use of New York State citizens’ tax dollars. I, however, would disagree – increased screening coverage would not only save lives, but it would also save the state money in the long run. Treating late stage breast cancer is extremely expensive compared to early stage cancer. Since screening should ensure that most breast cancers are caught and treated early, this will reduce the burden on the economy,[4] and especially on the state’s budget by reducing costs for Medicaid and Medicare Services, which insure a great deal of the people who would benefit from the new policy.

References

[1] https://www.ny.gov/new-york-state-breast-cancer-programs/new-york-state-breast-cancer-services

[2] http://www.cancer.org/healthy/toolsandcalculators/remind-me?_ga=1.268218890.549704867.1457131056

[3] http://www.stopthetaxshift.org/employee-relations/29-paid-leave-for-cancer-screenings-

[4] Mandelblatt, Jeanne, Harold Freeman, Deidre Winczewski, Kate Cagney, Sterling Williams, Reynold Trowers, Jian Tang, and Jon Kerner. “Implementation of a Breast and Cervical Cancer Screening Program in a Public Hospital Emergency Department.” Annals of Emergency Medicine 28, no. 5 (November 1996): 493–98. doi:10.1016/S0196-0644(96)70111-7.

 

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9 Responses to “A Patient Navigator’s Support for the New York State Breast Cancer Initiative’s 4-Hour Leave for Breast Cancer Screening”

  1. oluwatosinajayi Says:

    Thanks for sharing your insights on NY’s innovative methods for improving women’s access to preventative services. From reading this, I was wondering how the specific number (4 hours) was calculated and what the estimated leave frequency would be. And, also what kind of checks would be placed to prevent the abuse of this initiative. I also think it’ll be very interesting to see what the adoption would look like in the private sector and across the US and also across other disease states like colon cancer

    • socbehphcjm Says:

      Unfortunately I do not know why they settled on the 4 hour time period – presumably this was deemed enough time to travel to and from a diagnostic clinic and have the exam. While I have faith that this is accurate in densely populated areas like New York City, it may be less appropriate in NY State’s vast rural areas where such clinics may be spread further apart.

      With regard to abuse prevention, state employees currently have to fill out and submit a form stating when they are taking their 4 hour leave; since this leave is only permitted once annually, I believe the likelihood that they would attempt and succeed) at taking more absences is low.

  2. free62570 Says:

    This is a very interesting policy to expand preventive care to all women. As a primary care physician, I totally agree with the argument that the author made regarding treatment of early breast CA is more cost effective. Furthermore, it also improves survival rate in early detection. However, I was wondering if NY has any breast CA treatment program for women who are underinsured. It may not be beneficial for underserved women to detect early breast CA if they don’t have appropriate navigator program to help them with treatment process and understanding of breast CA.

    • socbehphcjm Says:

      Services for the underinsured are still a problem for women in NY. The state does provide funding to pay for cancer treatment for women diagnosed with beast cancer regardless of their insurance status, but unfortunately this does not apply to screening to my knowledge. The Affordable Care Act and Medicaid expansion have increased coverage for many women in New York State, but inevitably there are still those who do not qualify. These women will most likely rely on out-of-pocket payments or on grants from charitable organisations to receive care.

  3. joycehuryu Says:

    Thank you so much for sharing this! I do agree that this will save both lives and taxpayers’ dollars in a long run. I do wonder, however, whether the 4 hour leave is long enough to get the screening done including any travel time necessary. Regardless, I do believe that this initiative will raise public awareness and strengthen gender equality in the workforce by empowering women to take care of their health without having to jeopardize their employment status and/or their income.

  4. skbanergt Says:

    This is definitely an interesting concept which encourages increased usage of preventative measures for breast cancer. I am presenting about colon cancer prevention and colonoscopies at a family medicine conference. One of the biggest deterrents for this procedure is that usually a whole day is devoted to this procedure, leading to loss of productivity. In fact, Dong et al. (2011) found that if the procedure was mid-week, then the patient missed more days. Screening tests need to be at the forefront of a company’s health related policies because the short-term loss of productivity is miniscule compared to what the company would lose if the patient had colon cancer or breast cancer. Battling cancer is emotionally and financially draining leading to enormous loss of productivity.

    Reference:

    Dong MH, Kalmaz D, Savides TJ. Missed Work Related to Mid-Week Screening Colonoscopy. Digestive Diseases and Sciences. 2011;56(7):2114-2119. doi:10.1007/s10620-010-1545-2.

  5. madhunaga Says:

    Hi. I really enjoyed reading about this measure that seeks to concretely increase access to preventive services by protecting time off. Too often, I agree, people weigh social and economic pressures of taking time off vs the perceived health benefit, and because of the high rate of future discounting that most people have, fail to do their regular screening measures.
    I wonder, like some others above, why and how they came up with four hours – probably half a regular ‘work day’? – and if that might be enough time if the medical centre is located a distance away.
    Another concern I had was potential hostility towards this measure if implemented in isolation, because men may see this as women getting special treatment – as opposed to this measure being implemented for all kinds of screening measures across the board.
    But thank you once again for posting on this needed measure.

  6. mayriamroblesgarcia Says:

    Policies such as New York State Breast Cancer Initiative are the building blocks by which sustainable public health systems are sustained. In the subject of preventive medicine vs curative medicine, the debate is over; preventive medicine is more cost-efficient, gives patients’ better prognosis and is the most effective tool for disease. Whether 4 hours is enough to make this policy viable remains to be seen and only time will tell. Policies such as these should not only pertain to breast cancer but extend to other common diseases most notably prostatic cancer in men with rectal examination.

  7. Umar J Says:

    Thank you for this wonderful post. you mentioned that there are “numerous private sector businesses” such as M& T that have indicated their support, is there any specific eligible criteria that these organizations have to meet before they can participate?

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