Using Policy, Programs, and Partnerships to Stamp Out Breast and Cervical Cancers National Conference of State Legislatures Annual Meeting J August 2006 Christy Schmidt Senior Director of Policy National Government Relations Department
Cancer Incidence Rates* for Women, 1975-2003 Rate Per 100,000 250 200 150 Breast 100 50 0 Colon and rectum Lung Uterine Corpus Ovary Non-Hodgkin lymphoma 1975 1978 1981 1984 1987 1990 1993 1996 1999 2002 *Age-adjusted to the 2000 US standard population. Source: Surveillance, Epidemiology, and End Results Program, 1975-2003, Division of Cancer Control and Population Sciences, National Cancer Institute, 2006.
Cancer Death Rates* for Women, 1930-2003 Rate Per 100,000 100 80 60 40 Uterus Breast Lung 20 Stomach Colon & rectum Ovary 0 Pancreas 1930 1935 1940 1945 1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 *Age-adjusted to the 2000 US standard population. Source: US Mortality Public Use Data Tapes 1960-2003, US Mortality Volumes 1930-1959, National Center for Health Statistics, Centers for Disease Control and Prevention, 2006.
Trends in Breast Cancer Death Rates* by Race/Ethnicity, US, 1975-2003 50 40 African Americans 39% Rate per 100,000 30 20 Whites 10 0 1975 1979 1983 1987 1991 1995 1999 2003 *Age-adjusted to the 2000 US standard population. Data Source: Surveillance, Epidemiology, and End Results (SEER) Program, 1975-2003, Division of Cancer Control and Population Sciences, National Cancer Institute, 2006.
The National Breast & Cervical Cancer Early Detection Program (NBCCEDP) The NBCCEDP is a program administered by the CDC that brings life-saving breast and cervical cancer screening to poor, uninsured, and underserved women. About half of all women screened through the present program are from racial and ethnic minority groups. Over two and a half million women have been served. Over 22,000 breast cancers; 76,000 precancerous cervical lesions; and 1,500 cervical cancers have been diagnosed.
Eligible women can t participate in NBCCEDP due to lack of funding. Only 20% 21% of eligible women aged 50 to 64 years received screening through NBCCEDP. The Society s goal is to expand the program to screen more women. 21 79 Need Not Met by Program Women Served Source: The National Breast and Cervical Cancer Early Detection Program Fact Sheet 2004/2005. Department of Health and Human Services, Centers for Disease Control and Prevention. Atlanta, GA. 2005.
State Appropriations for Breast and Cervical Cancer Screening Programs WASHINGTON MONTANA NORTH DAKOTA MINNESOTA VERMONT MAINE OREGON NEW HAMPSHIRE IDAHO WYOMING SOUTH DAKOTA WISCONSIN MICHIGAN NEW YORK MASSACHUSETTS RHODE ISLAND CALIFORNIA NEVADA UTAH COLORADO NEBRASKA KANSAS IOWA MISSOURI ILLINOIS INDIANA OHIO KENTUCKY WEST VIRGINIA PENNSYLVANIA * VIRGINIA CONNECTICUT NEW JERSEY DELAWARE MARYLAND WASHINGTON, D.C. NORTH CAROLINA ARIZONA NEW MEXICO OKLAHOMA ARKANSAS TENNESSEE SOUTH CAROLINA ALASKA MISSISSIPPI ALABAMA GEORGIA TEXAS LOUISIANA FLORIDA HAWAII Provides state appropriations for breast and cervical cancer screening program (above and beyond state match) Does not provide state appropriations, but has secured funds from other sources to screen more women Relies solely on federal funding to screen women under the program Unpublished data from George Washington University (Prepared fall 2005) May, 2006
Source: CDC provided data, 9/06 WASHINGTON State Age Eligibility Requirements for Breast Screenings in NBCCEDP OREGON CALIFORNIA NEVADA IDAHO UTAH MONTANA WYOMING COLORADO NORTH DAKOTA SOUTH DAKOTA NEBRASKA KANSAS MINNESOTA (45) IOWA MISSOURI WISCONSIN ILLINOIS MICHIGAN OHIO INDIANA KENTUCKY PENNSYLVANIA WEST VIRGINIA * VIRGINIA VERMONT NEW YORK MAINE NEW JERSEY RHODE ISLAND CONNECTICUT DELAWARE MARYLAND WASHINGTON DC NEW HAMPSHIR MASSACHUSETT ALASKA ARIZONA NEW MEXICO OKLAHOMA TENNESSEE ARKANSAS MISSISSIPPI ALABAMA GEORGIA NORTH CAROLINA SOUTH CAROLINA (47) TEXAS LOUISIANA FLORIDA HAWAII States with Age Eligibility of 50 years and older States with Age Eligibility of 40 years and older
The Breast and Cervical Cancer Prevention and Treatment Act (BCCPTA) Thanks to passage of the BCCPTA, women diagnosed with cancer through the NBCCEDP become eligible for Medicaid. Before, women were provided with free screening but with no definite way to get treatment. All 50 states plus D.C. have chosen to implement this. For every dollar a state spends, the federal government adds between $2 and $5 in new funds.
Screening Options/Screening Approaches Major Source of Uncertainty Screening Approach defines meaning/scope of Screened under the Program (SUP) requirement for BCCPTA Medicaid eligibility Screening Approach required (Option #1) for all states: women who receive an NBCCEDP-funded service qualify as Screened under the Program Screening Approaches optional (Options #2, #3) for states to qualify women not receiving an NBCCEDP-funded service: Women qualify who receive services through state B/C cancer program Women qualify who receive services from providers designated as screening providers for BCCPTA Medicaid SUP requirement
States continue to consider cutting funds to BCCPTA Medicaid For every 1,000 women screened, 70 have had abnormal screens that require additional follow-up, and 5 of every 1,000 women were found to have breast cancer.* Cuts to Medicaid even for treating women with breast and cervical cancer are on the blocks. Advocates need to fight to protect these state Medicaid dollars. *Senate Finance Committee Report: Breast and Cervical Cancer Treatment Act, S. 662. 106th Congress. June 27, 2000.
Cervical Cancer and HPV vaccines
Cervical cancer mortality rates, 1990-2001 African American Hispanic Non-Hispanic White General Population
HPV Vaccine is Safe and Effective In June 2006, FDA approved Gardasil There is strong evidence that the vaccine will protect against four strains of HPV two strains responsible for 70% of cervical cancer cases and two strains that cause 90% of genital warts cases Federal Advisory Committee on Immunization Practices (ACIP) recommends vaccine for girls 11 and 12 years old ACIP recommendations are followed closely by healthcare professionals
Issues Surrounding HPV Vaccine Access Cost Healthcare system Coverage Private Vaccines for Children (VFC) Medicaid 315 Acceptability Physicians Patients
Know the policy Final Thoughts Invest resources in programs that work Partner with state health departments and community groups Continue to address disparities