When the D.C. Health Department's interim director, Herbert R. Tillery, learned that more than 400 needy women could not get low-cost mammograms and about 450 could not get Pap smears because of department mismanagement, he acted.
The retired Army colonel, who stepped into his job in March, unleashed a team of health educators, volunteers and cancer survivors on a two-week blitz of the city's east side. Outreach workers set up shop all over town.
Last week, in front of the Safeway supermarket at Benning and Bladensburg roads NE, they buttonholed virtually every female shopper 18 and older to recommend pelvic and breast exams. Uninsured and low-income women who were overdue for checkups were promptly referred for appointments through Project WISH (Women Into Staying Healthy).
The program provides a mammogram, a pelvic exam, a Pap smear, follow-up tests if necessary, free transportation for exams, case management if tests results are abnormal and free treatment if cancer is found. Earlier mismanagement led to the program's failure to screen many women, a failure that went unnoticed until cancer doctors publicly complained, Tillery said.
The program is designed to produce success stories such as that of Diane Harris Adams, 46, who was one of the contract outreach workers looking for women who need screening. She enthusiastically told her harrowing tale of surviving breast cancer, mastectomy and reconstructive surgery.
"If it weren't for Project WISH, I'm not quite sure the cancer wouldn't have spread all over my body," she said. "I've been cancer-free for a year. . . . People have to know there's life after breast cancer if you jump on it early and be aggressive with it."
She was joined by Nadine Winter, a former D.C. Council member who represented Ward 6 from 1974 to 1990 and is a breast cancer survivor. Winter, who is pushing Project WISH as energetically as if she were in a tight election battle, is working as a volunteer with 32 other survivors to promote screening. When news of the management problems broke, she showed up unannounced in Tillery's office to volunteer.
"We can't sit back and complain," she said.
Many doctors consider the tests essential in the early detection of cancer in the District, which has the nation's highest breast and cervical cancer death rates when compared with the 50 states, and the worst overall cancer mortality.
The effectiveness of Pap smears is not controversial, but mammograms for certain groups are. Although cancer experts agree that mammograms are valuable for women older than 50, there is no consensus that routine mammograms help women younger than 50.
Some women's lives are saved by mammography, but many detected cancers might never have killed the patient if undiscovered, some specialists say. Some cancers kill despite early warning, and others are curable even if detected later, they say. Nevertheless, federal officials recommended in 2002 that women older than 40 be screened at least every other year.
Tillery and his chief of staff, Cheryl Edwards, say that things are getting back on track and that hundreds of women are signing up. The unspent federal grant for Project WISH is likely to be extended into the fiscal year starting this week, and federal grant money for 2005 is already in hand, he said. Talks have begun with cancer doctors to rebuild the trust damaged by the episode.
"Whatever we've been doing at the Health Department hasn't been working," Tillery said. "We're going to figure out how to do it different."
Eligible District residents can arrange free screenings by calling Project WISH at 202-442-5900.