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This article reports on a 3-year (1989-1992) American Cancer Society demonstration project in which a multidisciplinary, continuity-of-care-based comprehensive cancer prevention, education, and early detection clinic was established within an already existing inner-city health center in West Oakland, California. A total of 2058 patients (79% African-American, 78% female, 50% medically uninsured) received 7349 services (3.6 services per patient; averaging 2.5 hours over multiple visits, with 75%-85% appointment-keeping compliance), ranging from risk assessment and education to physical examinations, smoking counseling, mammography, and flexible sigmoidoscopy. In addition to 22 precancers and 15 cancers being diagnosed, statistically significant gains were demonstrated in patient knowledge, attitudes, and behavior. There was high patient satisfaction, particularly with nurse practitioners as service providers. Cancer prevention education was provided to an additional 14,945 community members, targeting students, teen parents, and recovering substance abusers. An in-depth qualitative analysis of recovering substance abusers examined their cancer beliefs and attitudes and showed significant knowledge gains from a subsequent cancer education program. The overall project demonstrated the feasibility of providing comprehensive and effective cancer prevention, education, and early detection services to the poor.

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