Dr. Sheryl Gabram Wins Health Care Heroes Award

June 2010

For her work reducing breast cancer mortality, Dr. Sheryl Gabram was named winner of the 2010 Atlanta Business Chronicle Health-Care Heroes Community Outreach award. Dr. Gabram and her team at the AVON Comprehensive Breast Center at the Georgia Cancer Center for Excellence at Grady Memorial Hospital have managed to increase breast cancer awareness and diagnose the disease earlier in a high-risk population of minority women.

"The results at Grady Memorial Hospital for women suffering with breast cancer speak for themselves," said William Todd, Georgia Cancer Coalition president and CEO. "She has set up a system and a program in the AVON Breast Center that rivals any private health-care system in the community and that is equivalent to the finest private hospitals in Atlanta with a very challenging population."

Of an estimated 40,000 women in the U.S. who die from breast cancer annually, a disproportionate number are likely to be black women, due in large part to the fact that African-American women are diagnosed at a later stage of the disease when breast cancer tends to be more aggressive.

"There is about a 33 percent higher mortality rate for African-American women, specifically as it applies to women at Grady, since many of our women lack the access to high-quality medical care," says Dr. Gabram. "It's not only about being African-American, it's the poverty issue that is so important. It's about access to care, too."

Recruited in 2005 to serve as director of the AVON Comprehensive Breast Center, Dr. Gabram became the head of a program established by Dr. Otis Brawley, former medical director of the Georgia Cancer Coalition Center of Excellence at Grady Memorial Hospital.

With support from the AVON Foundation, the breast center program includes a community outreach initiative aimed at raising awareness about breast health and encouraging mammography. Community health advocates are recruited locally and trained by staff at the AVON Breast Center to conduct presentations encouraging women to overcome fears, cultural misconceptions and barriers to getting screened for breast cancer. Breast cancer survivors also serve as patient navigators, helping patients diagnosed with breast cancer pursue medical care; keep appointments; and deal with financial concerns, communications difficulties and transportation issues. They also work with social workers and case managers to help patients' access resources and overcome obstacles to care.

"These are women in the community who are breast cancer survivors who are funded through the AVON Foundation to be available to talk to our patients when they are newly diagnosed as well as when patients don't show up for their mammograms and biopsies," Dr. Gabram says. "The concept is women of the community out in the community."

Since her arrival, Dr. Gabram has built upon the foundation of the program, initiating practices to ensure quality care for the patients that visit the center.

"When I first came here, we were six months behind in giving a mammogram at Grady and we had to fix that and we had to fix that overnight. In three months we were able to fix that," she says.

The combination of outreach and easing the access to quality care has proved successful. The AVON Center increased its mammography exams from 11,000 in 2005 to more than 16,500 in 2009.

"Once you increase the mammography your going to increase the number of cancers you diagnose and then increase the number of cancer at an earlier stage," she says.

From 2001 to 2004, the proportion of early-stage breast cancer diagnosed increased from 12.4 percent to 25.8 percent and the proportion of Stage IV invasive breast cancer diagnoses decreased from 16.8 percent to 9.4 percent. In 2006, 46 percent of patients presented early-stage breast cancer and only 26 percent with Stage III or IV.

"She has downgraded breast cancer diagnosis, where previously women would come in presenting with stage III or IV breast cancer, today the majority of women come in presenting stage 0 to I," Mr. Todd said.

In 2009, the AVON Foundation awarded the Center a $750,000 grant to continue community outreach, education, clinical access and four research studies affecting cancer cure for under-served populations in Atlanta. Another grant from the Susan G. Komen for the Cure Greater Atlanta Affiliate allowed for the expansion of patient navigation services to include home visits, support groups and patient incentives.

"It's about all the work that my team does; it's not me solely, I want to emphasize that," Dr. Gabram says. "The Rollins School of Public Health was assigned to oversee the community outreach program and I really want to make sure they are mentioned as a partner in the work that we do as well."

Despite her desire to credit others, Dr. Gabram's leadership role during a turbulent time at Grady Hospital has been a key component to the AVON Center's success, including the Center being granted a full accreditation designation by the National Accreditation Program for Breast Centers in February. Grady is the only public hospital program in the Southeast region to earn the accreditation.

Recently named deputy director of the entire Cancer Center for Excellence at Grady, Dr. Gabram now hopes to expand these heroic efforts into other types of cancers.

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