For 12 years, Danielle Nevers delayed getting a mammogram. For starters, she was afraid it was going to hurt. And she had no idea how to access the screening, which is recommended for women beginning at age 40.

But when Gabrielle Flowers, Breast Health Equity Program coordinator at Fred Hutch Cancer Center, personally reached out to encourage her to get screened and offered to arrange transportation to one of Fred Hutch’s two mobile mammography vans, Nevers agreed.

She had her first mammogram last year and recently followed up with her second, aligning with annual screening guidelines for women. Now she’s an evangelist for the importance of screening within the Black community and urges her friends and neighbors to get screened.

“People kept saying, ‘Girl, that is going to hurt you so bad,’” said Nevers. “I might be the only one to say this, but that mammogram did not hurt. I regret that I waited all those years.”

The mobile mammography vans — “mammovans” for short — are intended to remove barriers that people such as Nevers face accessing mammograms in under-resourced communities. Nevers is a patient at Seattle Roots Community Health, home of Carolyn Downs Family Medical Center, which provides health care to people regardless of their ability to pay. Fred Hutch connected to Seattle Roots through a community event a couple years ago and partnered with the clinic to identify a list of patients overdue for various medical screenings. Nevers was on that list.

Flowers contacted her and offered Nevers an appointment and a ride from a Lyft driver; the fare was paid by a grant from the National Breast Cancer Foundation. That logistical support turned out to be just what Nevers needed to persuade her to get screened.

Offering mammograms throughout Puget Sound

Black women have lower rates of breast cancer screening and in her role, Flowers acknowledges that reality, promoting the importance of mammograms to under-resourced communities. She highlights the mammogram vans, which travel around the area to make it more convenient for people to get screened in their communities instead of traveling to Fred Hutch clinics.

Flowers partnered with colleagues at UW Medicine Primary Care and Population Health to identify Black women in need of screenings.

Analyzing ZIP codes, they found that 98118 has significantly lower screening rates, along with south Seattle and Burien. “That is why we are having our vans go out there at least once a quarter to build our presence there,” she said.

She also worked with UW Medicine to send out a survey to “no-shows” — people who miss their scheduled mammogram appointments — to better understand why they don’t show up. Enough women listed transportation as a challenge that Fred Hutch launched a program to pay for rides.

"My job is to help remove barriers that get in the way of getting screening,” Flowers said. “If a patient needs a ride because that’s a barrier, we can order a ride to and from their appointment.”

Fred Hutch’s first mammogram van launched more than 20 years ago. A second van joined the fleet in 2020. The term “van” is not entirely on point; the mobile clinic more closely resembles a semitruck and operators must have a commercial driver’s license.

The mammogram vans can each perform nearly two dozen scans per day throughout the Puget Sound region, from Marysville to Tacoma. They operate six days a week with patients scheduled months in advance. Only screening mammograms are offered on the vans. If a potential problem is detected, patients are followed up with diagnostic mammography at Fred Hutch’s main South Lake Union campus. Because Fred Hutch serves as the cancer program for UW Medicine, patients have the option to complete their screenings with either organization.

And the vans are popular.

“We were 10% over our goal year over year in 2024,” said Le Ann Yoder, mobile operations manager.

Fred Hutch has partnered with the Seattle Indian Health Board to provide screenings on a bi-monthly basis and recently launched a new partnership with the Muckleshoot Tribe in Auburn.

“We thought we would try to go once a quarter, but as we were registering patients for the first date, they were immediately asking for more dates because there was such demand,” Yoder said. 

Building trust

The increased interest in getting screened is encouraging, said Fred Hutch breast oncologist Natasha Hunter, MD, who notes that the earlier breast cancer is detected, the less chance women have of being diagnosed with incurable metastatic disease.

“Mammography is so critical,” she said. “The more we can reach populations that haven’t been as aggressively screened, the better. Historically and for good reasons, there has been mistrust among certain populations that needs to be overcome. One way we can do that is through this kind of outreach. We have to partner with community leaders and build those ties so we can increase trust.”

Building trust played a significant role in Nevers’ decision to finally get screened.

“I was supposed to get a mammogram starting when I was 40, but I was 52 when I finally went,” she said. “Do you see how long I was scared?”

Nevers said her relatives and friends fear that mammograms will be painful. Few people will say that getting a mammogram is comfortable, but Nevers said she experienced “no pain at all.”

“So many women I know in the Black community are scared,” she said.  “I tell them, ‘Honey, it didn’t hurt me.’”

This year when she got a reminder letter from Fred Hutch prompting her to schedule her annual screening, she didn’t ignore it.

“I have white coat syndrome, and I am going back happily,” she said.

Learn more about scheduling mobile mammography.

SIDEBAR

Learn more about breast cancer screening

Mammograms are the first line of defense when it comes to breast cancer screening. But cancer can be harder to detect via mammography in women who have dense breasts. About 50% of women over the age of 40 have dense breasts, which refers to the degree of non-fatty tissue that a mammogram identifies.

Cancer and dense tissue both appear white on a mammogram, which can make it challenging to differentiate between the two. And mammograms have difficulty picking up lobular breast cancer, a subtype that accounts for 15% of breast cancer cases.

Women with dense breasts may be advised to pair a breast MRI with an annual mammogram to better detect cancerous changes.

Learn about breast cancer screening and breast density in relation to breast cancer risk.

Bonnie Rochman is a staff writer at Fred Hutchinson Cancer Center. A former health and parenting writer for Time, she has written a popular science book about genetics, “The Gene Machine: How Genetic Technologies Are Changing the Way We Have Kids—and the Kids We Have.” Reach her at brochman@fredhutch.org.

This article was originally published by Fred Hutch News Service. It is republished with permission.