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2003 Fact Sheet – Revised May 2004The National Breast and Cervical Cancer Early Detection Program — Reducing Mortality Through Screening
IntroductionThe National Breast and Cervical Cancer Early Detection Program, administered by the Centers for Disease Control and Prevention (CDC), helps low-income, uninsured, and underserved women gain access to lifesaving screening programs for early detection of breast and cervical cancers. Many deaths from breast and cervical cancers could be avoided by increasing cancer screening rates among women at risk. Deaths from these diseases occur disproportionately among women who are uninsured or underinsured. Mammography and Papanicolaou (Pap) tests are underused by women who have less than a high school education, are older, live below the poverty level, or are members of certain racial and ethnic minority groups. Studies show that early detection of breast and cervical cancers saves lives. Timely mammography screening among women aged 40 years or older could prevent approximately 16% of all deaths from breast cancer. Pap tests can find cervical cancer at an early stage when it is most curable, or even prevent the disease if precancerous lesions found during the test are treated. Mammography is the best available method to detect breast cancer in its earliest, most treatable stage— an average of 1 to 3 years before a woman can feel a lump. Women aged 40 years or older should have a screening mammogram every 1 to 2 years. Cervical cancer screening using the Pap test detects not only cancer but also precancerous lesions. Women should begin getting a Pap test within three years of onset of sexual activity or age 21, whichever comes first and screening at least every three years.
CDC Activities Target Early DetectionTo help improve access to screening for breast and cervical cancers among underserved women, Congress passed the Breast and Cervical Cancer Mortality Prevention Act of 1990, which created CDC’s National Breast and Cervical Cancer Early Detection Program (NBCCEDP). This program, funded at $200.6 million for fiscal year 2003, provides both screening and diagnostic services, including
Since it was established in 1991, the program has been implemented in all 50 states, 6 U.S. territories, the District of Columbia, and 15 American Indian/Alaska Native organizations. To date, it has
NBCCEDP continues to support an array of strategies that work together synergistically to achieve these results. Examples of some of these strategies are described in the sections that follow.
One partnership effort involves the Bureau of Primary Care (a division of the federal Health Resources and Services Administration [HRSA]) and the community health centers that it funds; the Institute of Healthcare Improvement; the National Cancer Institute (NCI); CDC; and other organizations. This project is focused on increasing screening for breast, cervical, and colorectal cancers within the populations served by community, migrant, and homeless health centers, as well as on improving follow-up for patients with abnormal screening results. Health center personnel are learning how small, incremental changes in clinic practices (e.g., linking screening to nonroutine clinic visits) can lead to improved health outcomes for the populations they serve. They are being taught how to plan and pilot-test such changes as well as how to assess and use test results in implementing effective changes. Another important CDC partner, Avon, makes available about $5 million every year to help community-based organizations recruit women for breast cancer screening. During 2003, Avon is working to improve links between these organizations and NBCCEDP grantees. Also, through the Avon-CDC Foundation Mobile Access Program, a grant of more than $4 million will fund at least four mammography vans to expand services for medically underserved women through NBCCEDP. NBCCEDP grantee organizations in many states have joined with nontraditional partners, including Native American tribal leaders, councils on aging, and church groups, to offer education and outreach in community settings. Diverse partners and varied intervention strategies have successfully brought screening services to women living on American Indian reservations and in rural and inner-city areas. For example, with grants from NBCCEDP and added support from Avon and the Susan G. Komen Foundation, the Native Women's Wellness Program of the South Puget Intertribal Planning Agency has steadily expanded its outreach to women in the five tribal communities of Washington State. Native American outreach workers and tribal health care providers have built relationships of mutual trust and respect with these women, and their work continues to increase the number of women who receive screening through this program. Public Education and Outreach: Eliminating Barriers to Access An example of such progress was provided by the nation's first statewide Asian-language, breast cancer hotline, which was established by the Every Woman Counts Program of the California Department of Health (an NBCCEDP grantee). This service provided information in Chinese (Mandarin and Cantonese dialects), Korean, and Vietnamese languages. (Assistance was already offered in English and Spanish.) A public awareness campaign employed radio and print public service announcements in Mandarin, Cantonese, Korean, and Vietnamese to publicize the hotline. The number of calls to the hotline subsequently increased by more than 200%. Professional Education: Enhancing Health Care at the Source Screening, Follow-Up, and Case Management A recent example which illustrates the role of case managers involved a Missouri woman with breast cancer who was unemployed, depressed, and in need of chemotherapy. Case managers with the Breast and Cervical Cancer Control Program (BCCCP) of the Missouri Department of Health and Senior Services work with various organizations to assist individuals and families affected by breast cancer. In this instance, a BCCCP case manager sought help from several organizations, including the Breast Cancer Foundation of the Ozarks, which paid the woman's rent and utilities for 3 months. The American Cancer Society provided a wig and other support. The woman finished treatment and is doing well in her own home. Quality Assurance for Screening and Follow-Up In the New York Breast and Cervical Cancer Early Detection Program, health care providers are recruited by local Healthy Women Partnerships to supply breast and cervical cancer screening and diagnostic services. Providers must meet standards set by CDC and the state health department and must be certified by the U.S. Food and Drug Administration to conduct mammography screening and diagnostic follow-up. An interdisciplinary quality-assurance team reviews screening data received from almost 800 providers across the state, comparing each provider's aggregate test results with expected results based on state and national data. These reviews alerted program officials to a quality-assurance issue in one facility where the number of breast cancers detected was less than 25% of the number expected. Improving Access to Treatment CDC Research ActivitiesCDC conducts research to develop effective strategies for improving communications, education, outreach, and outcomes associated with its breast and cervical cancer control activities. Below are some recent examples of this research.
Future DirectionsCDC estimates that NBCCEDP services are currently reaching approximately 15% of women aged 50 years or older who are eligible for the program. CDC will continue working—through research, partnerships, and grantee organizations—to increase access to breast and cervical cancer early-detection and treatment services, to develop strategies for improving rescreening rates among women enrolled in the program, and to implement public education and outreach strategies capable of reaching women who have rarely or never been screened.
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