Her role: Expanding access to health care, one mammogram at a time

For the past decade, she has coordinated two mobile units in Forsyth County and one in Rowan County. (In addition, Novant Health has two in Charlotte and one at the North Carolina coast.) The schedule is full a year or more in advance. October is always packed – including on Saturdays – since it’s Breast Cancer Awareness Month.

The units visit hundreds of sites each year, including businesses, community sites and medical practices – including many places in Winston-Salem where patients who may be uninsured or underinsured receive medical care. The units also go regularly to Novant Health clinics to screen patients at their doctors’ office.

“Our goal is to eliminate barriers and to make getting a mammogram as easy as possible,” Sewell said.

Sewell’s official title is community engagement specialist, but her passion is preventive care such as mammograms. She also works with the Novant Health grant writers to apply for grant funding, which allows uninsured women to get mammograms – and leads breast health education efforts.

The former University of Michigan professor takes her role seriously – as an academic would – and aims to know as much as she can about breast health. In addition to her doctorate in public health and health behavior, she is an ARRT-certified (American Registry of Radiologic Technologists) radiographer and is close to having her mammography certification.

That certification will be another achievement for the professor who taught biostatistics, epidemiology, anatomy and physiology.

Sewell’s immersion into health care advocacy began in earnest when her daughter – then 12 and now 40 – lost an eye as the result of a bottle rocket accident.

Sewell became her daughter’s aide in school and advocated for things like large-print books so she could keep up with her classmates. By 16, her daughter had learned Braille, and she told her mom she no longer needed her help at school. She’s been entirely self-sufficient for decades and just earned her own Ph.D. in accounting.

Sewell was on the faculty at U-M from around 2000 to 2012 when she relocated to Winston-Salem to be near an aunt who was aging. Instead of continuing her career in higher education, she went with her passion for caring for others and joined Novant Health, where she worked her way into her current position.

“It’s not money that makes me happy,” she said. “Helping others is what I love to do. I’ve asked myself, ‘What if I won the Powerball or Mega Millions?’ The answer is that I’d be right here.”

Going where the need is

The mammography units, housed inside 38-feet-long motor coaches, will go anywhere there’s a need, but Sewell places an emphasis on getting to underserved and uninsured populations. The units travel about a 60-mile radius from their home base.

Two techs are on the mobile units, and one or the other doubles as the driver. If the unit is going to a heavily Hispanic area, a Novant Health medical interpreter will meet the mobile unit at the site.

A mobile unit crew can screen 35 patients during a typical (9 a.m. to 4 p.m.) shift. About 10% of women screened on any given day will have an area that requires further diagnostic breast imaging, said Sewell.

The units are usually fully booked weeks in advance, but occasionally, the techs can take a walk-in or two – as long as the potential patient has a primary care clinician.

“Every woman screened at a mobile unit must have a health care clinician to receive the results from the exam,” said Sewell. “It can be a primary care physician, an OB-GYN, nurse practitioner, physician assistant – but there has to be someone (besides the patient) to receive results.

“If a woman doesn’t have a primary care clinician, we’ll give her the number for Consumer Access (a resource provided at no charge by Novant Health) to get her connected.” That number is 844-553-8370, Option 1.

Once the mobile unit returns, the images taken that day are downloaded and interpreted by a radiologist. Once interpreted, results are then available to the patient’s health care clinician and the patient via MyChart and a mailed letter.

Anyone whose imaging showed something that needs a closer look will get a phone call asking her to schedule follow-up diagnostic breast imaging. Follow-up appointments can be scheduled by phone or by requesting an appointment via Novant Health’s Breast Health website at NovantHealth.org/pink.

Still a threat

About 43,700 women will die from breast cancer this year, according to the American Cancer Society.

Breast cancer is the second leading cause of cancer death, behind lung cancer, in women. While breast cancer death rates have been going down since 1989, the decline has slowed slightly in recent years. The decrease in death rates may be the result of early screening and increased awareness, as well as better treatment.

In April, CNN reported on a study in the journal JAMA Network Open that points to clinical trials being “warranted to investigate whether screening guidelines should recommend Black women start screening at younger ages, around 42 instead of 50. ‘Clinicians and radiologists should consider race and ethnicity when determining the age at which breast cancer screening should begin,’ Dr. Mahdi Fallah, an author of the new study … said in an email.”

Fallah goes on to say that policymakers should “consider a risk-adapted approach to breast cancer screening to address racial disparities in breast cancer mortality.”

Novant Health recommends mammograms for all women starting at age 40, or younger if there’s a family history. The American College of Radiology’s (ACR) guidelines “call for all women – particularly Black and Ashkenazi Jewish women — to have a risk assessment by age 25 to determine if screening earlier than age 40 is needed. The ACR continues to recommend annual screening starting at age 40 for women of average risk, but earlier and more intensive screening for high-risk patients.”

Sewell is gratified by the work she does. While she doesn’t ride on or work in the mobile unit, she does have contact with patients – many of whom write letters to share their gratitude for easy access to a mammogram. “They’re always very thankful,” she said, “especially if they’re diagnosed with cancer and can begin treatment early.”

Novant Health is helping make it possible for women to have no excuse not to get a yearly mammogram. The message Sewell most wants to share with women? “Depending on the type and stage of breast cancer, it’s 99% curable if detected early,” she said.