An NCI-designated Comprehensive Cancer Center
By Dory Benford | July 31, 2017
Mayra Serrano, M.P.H., C.H.E.S. Mayra Serrano, M.P.H., C.H.E.S.

For people living in minority and underserved communities, the divide between patients and health care providers can be hard to overcome.

These patients can feel that their concerns are not being heard, their doctors don’t understand where they’re coming from culturally or linguistically, or that they are being condescended to.

Sadly, these communication breakdowns can be fatal when individuals skip recommended cancer screenings or ignore cancer-related symptoms they may be experiencing, all to avoid doctor visits.

At City of Hope, the Center of Community Alliance for Research & Education (CCARE), seeks to facilitate better communication between minority patients and health care practitioners by fostering strong partnerships with community organizations.

We spoke to CCARE’s manager, Mayra Serrano, M.P.H., C.H.E.S., about the methods they use to bring their cancer prevention messages to the community.

There are several reasons that people living in minority or underserved communities may be hesitant to seek medical care.

“The most common thing I hear is that people are afraid screening exams are going to hurt — that they’re painful. They feel they don’t need it because they feel fine, and we’re talking about prevention and screening for things you don’t have. This isn’t something where you are sick and you have a cold, so you want to go to the doctor. It’s a hard sell, because we’re asking people to go through sometimes invasive procedures when they’re not sick,” said Serrano.

“The cost is another issue. Sometimes people are uninsured or can’t take time off work. A lot of it, too, is just lack of knowledge. People don’t know that they need these services. They don’t know that they need a mammogram every year after 40, or a colonoscopy after 50, or a pap test every three years after the age of 21. I hear a lot of that.”

Taking all of these concerns into consideration, CCARE forges inroads with these communities by meeting people where they are, bringing important cancer prevention and screening information directly to communities commonly left out of the health care discussion.

“I think out biggest strength is our community partnerships. We partner with churches, clinics, grassroots organizations, survivor advocates, support groups, schools. I’ve even been to people’s living rooms,” said Serrano.

“At CCARE, our first question is always what can we do for you? Not, what can you do for me? We’re offering them our services. It takes time to build these partnerships. Years, even.”

CCARE arranges community events with these partners, bringing in nurses, doctors and health educators to inform community members about cancer prevention, and sometimes even provide screening exams like mammograms to detect breast cancer or PSA tests to find prostate cancer. If exams are not being completed on site, team members are armed with information on where people can find low cost health care services.

Another important objective of these events is to calm any fears and anxieties people may have about being screened.
“Several cancer screening exams, like pap tests, colonoscopies and digital rectal exams, are invasive. It’s difficult to subject yourself to those tests if you don’t have a health care practitioner that you trust,” said Serrano.
At CCARE, those fears are never minimized or dismissed.          
“People are suddenly engaged when you validate their concerns. Letting people know that you really hear them, and you understand where they are coming from, can make all the difference.” said Serrano.
But often times, the needs of the community are not medical in nature.
“Something that helps us a lot in reaching this population is understanding that sometimes their need has nothing to do with cancer. Sometimes their need has to do with finances. Sometimes it has to do with paying their electric bill or finding affordable food or legal aid or their insurance,” Serrano explained.

“I think City of Hope understands that as a comprehensive cancer center, sometimes cancer isn’t the community’s number one concern. We have to be responsive to the community’s other needs as well. If they don’t have enough money to pay for their rent, we have information and details for organizations that will help them. Sometimes we have to address those concerns first.”

In the end, CCARE’s success comes down to making strong connections within minority communities, nurturing those relationships and building trust so that they can provide people with the tools necessary to take control of their health.
During Serrano’s time at CCARE, she has seen the organization expand their reach, and she’s optimistic about its continued success.
“I’ve seen many positive changes over the last 10 years. When I started, we didn’t have as much and we weren’t as focused on prevention. Now we have the Community Benefit Advisory Council that’s guiding a lot of our work and we have a lot of strong partnerships. We still have room to improve, but over the last 10 years there’s been a huge difference,” said Serrano.
Hopefully the next 10 years will see an even greater numbers of community events, cancer screenings and, most importantly, lives saved. 


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