Baltimore City Cancer Program offers free screenings, support to uninsured

Linda Adamson knew something was wrong even before she saw a doctor.

For weeks, she hoped the hard knot in her left breast would go away on its own – that it was just a strange side effect of her menstrual cycle. But when her mother felt it and looked concerned, Adamson started worrying, too.

She knew she needed a mammogram, but it was 2012, and she was working at a temp agency that didn’t give her health insurance. So Adamson, 46 at the time, dialed the Baltimore City Cancer Program – an organization run by the University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center that had helped her get a free pap smear earlier that year.

Days later, she found herself in tears on an examination table as a doctor told her the lump appeared abnormal. She’d soon be diagnosed with Stage 3 breast cancer — a disease that would require intensive chemotherapy and for Adamson to stop working while she recovered.

But the day after her mammogram, when she visited the West Baltimore office for the Baltimore City Cancer Program, a community outreach worker made her a promise.

“I’m here for you,” Loretta Setzer told Adamson. “We’re gonna do everything. I know you don’t have no insurance. Don’t worry yourself, because you got enough going on. You don’t need to stress yourself anymore.”

The cancer prevention program has been making — and keeping — similar promises to uninsured and otherwise disadvantaged people in Baltimore for more than two decades.

Since 2001, the program has provided free screenings to nearly 40,000 city residents and found 152 cases of breast cancer, along with a handful of cervical, oral and colorectal cancers. And 93% of people who were diagnosed through the program are alive today — a statistic that Rhonda Silva, a registered nurse and division administrator for the program, said “speaks volumes for all that we’ve done.”

While the program used to focus on caring for people without health insurance, that changed after the Affordable Care Act boosted the number of insured people in Baltimore. Now, the program also serves those who are underinsured — people who have insurance, but struggle to afford out-of-pocket health care costs. It targets breast, cervical and colorectal cancers when educating community members and providing free screenings, transportation to appointments, support groups, patient navigation and other services.

The program gets most of its funding — about $1.2 million a year — from the Cigarette Restitution Fund . Similar to the money now flowing into the state and city from lawsuits against opioid companies, money in the Cigarette Restitution Fund is from a massive 1998 settlement between most of the country’s attorneys general and the tobacco industry’s biggest players.

In the program’s early stages, many of the people it served were Black women who didn’t have insurance, Silva said. Since the passage of the Affordable Care Act, though, the patient population has shifted to include a higher percentage of Hispanic and Latino people, some of whom have concerns around their immigration status and don’t have insurance.

Research shows that both groups are less likely to get regular screenings for breast, cervical and colorectal cancer, and more likely to be diagnosed late — something that can worsen a patient’s outcome, said Dr. Shana Ntiri, the program’s medical director. She pointed to the program’s high survivorship as proof it’s possible to shrink disparities in cancer screening.

“When thinking about the patient population we serve, you hear a lot of stereotypes, to be frank. Like, ‘Oh, these folks will never do this and never do that,’” she said. “That’s not true. When people have information, when they have access, when they have guidance, they’ll absolutely do what they need to do in order to optimize their health. But you have to give them true opportunity.”

Community outreach is among the most important services the program provides — and in that area, Loretta Setzer, the community outreach worker who spoke with Adamson after her mammogram, is a local celebrity. She even has a nickname among her coworkers: the Pied Piper of Baltimore.

Setzer, who has been an outreach worker with the program since its start, passes out informational flyers every time she rides the bus. She said she can tell when someone is lying to her when she asks for the last time they got a cancer screening.

At 78 years old, Setzer knows how to get people to trust her. And she’s not afraid to crack jokes to lighten the mood.

“If you don’t want to do your own self-examination,” she’ll tell women, “let your boyfriend examine your breasts.”

Veronica Duran, one of the program’s three outreach workers who speak Spanish, laughed as she described Setzer’s persistence in getting someone to agree to a screening. Sometimes, Duran said, if Setzer sits beside someone on the bus or runs into a construction worker in her neighborhood who speaks Spanish, she’ll give Duran a call and ask her to translate.

Language barriers supply an additional challenge for non-native English speakers who are diagnosed with cancer, Duran said. Even though hospitals provide interpreters, it can be hard for non-native English speakers to keep up with the information overload that often happens at doctor’s appointments. Duran encourages her patients to carry a notebook and write down any questions that come to mind throughout their day.

“There’s no little question, no big question, no dumb question, no smart questions,” she tells patients. “Every single little question or thought that you have matters, and you need to get an answer.”

In 2014, two years after Adamson’s first breast cancer diagnosis, the cancer came back. She couldn’t see her oncologist at the Greenebaum Cancer Center any longer, since he didn’t accept her insurance, but one of her “survivor sisters” from the cancer program’s support group helped her find a new doctor at Mercy Medical Center.

Ten years later, Adamson takes a chemotherapy oral medication and gets regular screenings to moderate the cancer’s growth. But she likes to focus on the positives — the fact she can watch her eldest granddaughter, Treasure, play basketball in high school and see her youngest granddaughter, Peace, smile.

She said she thanks God every day for the doctors who treat her, the researchers searching for a cure — and for the Baltimore City Cancer Program.

“I feel like if it wasn’t for them,” she said, “I wouldn’t be here today.”