1. Partnering To Increase Cervical and Breast Cancer
Screening Among Rarely and
Never Screened Women

2. This project could save a life.”
“On a very personal note, I realized how
fortunate I am to have the resources to
have routine mammograms and Pap tests.
This project could save a life.”
--Team Up Partner

3. What is Team Up?
Team Up is a national partnership to increase cervical and breast cancer screening among rarely and never screened women.
State teams work with high mortality counties to encourage women to be screened for cervical and breast cancer.

4. Who Are the National Partners?
In addition to the National Partners, there are 6 State Teams

5. State Teams
The state teams are Alabama, Georgia, Kentucky, Illinois, Missouri, Tennessee, and South Carolina. In the beginning, there were 8 state teams, which included Mississippi, but due to several different factors, Mississippi was unable to continue participating with the pilot. However, they are still committed to reaching rarely/never screened women within their state.

6. Primary Goal
Increase screening in high mortality counties among women who have rarely or never been screened for cervical or breast cancer.

7. Objectives of Team Up Keeping our REP
R: rarely/never screened women as our audience;
E: evidence-based interventions as our approach;
P: partnerships as an overarching theme/strategy.
REP is what we live by. If we keep our REP, we know that we can effectively reach rarely or never screened women.
Rarely/never screened women: Rarely/never screened women never have had a Pap smear or mammogram or do not follow the guidelines for frequency of cervical and breast cancer screening. For instance, the CDC defines a rarely/never screened woman as a woman who has not been screened for cervical cancer in the past five years.
Evidence-based interventions: There have been several definitions for “evidence-based” practices in the past. Originally conceived as “evidence-based” medicine, it was defined in terms of the best proven clinical practice. What we mean by “evidence-based” is less clinically-focused. An evidence-based intervention has been implemented with a group and determined through some type of sound evaluation, to possess a degree of effectiveness or efficacy. Evaluation methods could have been as simple as a pre- and post-questionnaires or use of valid behavior change measures or as intricate as multiple methods for data collection and analysis. An “evidence-based” program is not always completely effective; however, we promote using evidence-based interventions because we know that they had some effect on the community of original implementation and therefore are a good starting place. Evidence-based programs can be more cost effective. They shorten the development process and duration, reduce the formative research needed, and help narrow evaluation procedures.
Partnerships: The goal of the TEAM UP partnership is to create synergy: a state in which each partner is a resource and together they create a stronger unit. Synergy provides the opportunity for each partner to volunteer her/his strengths, experience, skills, and knowledge in order to achieve what the individual could not do alone.

8. Why Rarely or Never Screened Women?
5%-10%
False negative
test
10%-15%
Abnormal test,
patient lost to
follow-up
Never or
Rarely Screened
50%-60%
Abnormal test,
case
mismanaged
10%-15%
Cervical cancer mortality reduction began in the 1950’s with the introduction of the Pap Smear and the rates have been sharply declining since. However, recent trends suggest that mortality is beginning to plateau. According to researchers, approximately 60% of all women who die of cervix cancer have either never been screened or not screened in the past 5 years. With these startling statistics and the availability of effective screening and treatment for early stage cervical cancer, Team Up has the potential to reduce cancer mortality for to reach rarely or never screened women.
Rapidly progressive
Uncommon
cancer
difficult to detect
5%-10%
Sources:NIH Consensus Conference
Janerich, Connecticut
Sung, California
9%-12%

9. US Mortality Female Breast Cancer
Why Rarely or Never Screened Women?
US Mortality Female Breast Cancer
15-44
15+
45-64
65+
Breast Cancer is the second leading cause of cancer death for women. In the mid 1990’s Breast cancer mortality trends began decline, which may be associated with the implementation of the CDC Breast & Cervical Cancer Screening program. However, the CDC BCCEDP program reaches only a small portion of the eligible population (approx. 14%). Based on those statistics, it is imperative that Team Up focuses on rarely and never screened women.
Source: NCHS Mortality Data. Age-adjusted to 2000.

10. Why Evidence?
Evidence based methods link scientific evidence to health programs or clinical practice recommendations.
Team Up focuses on adapting and replicating evidence based practices to reach rarely or never screened women.
In the last decade, we have seen a growing interest in evidence-based prevention. There are several explanations for this. The first has to do with accountability: With fewer dollars available for prevention, funders want to make sure that their money is being used wisely. Pressure for accountability is strongest at the federal level, but it is also mounting at the State level and among private foundations. Agencies simply don't have the funds to support programs that look or sound good but haven't been shown to produce positive outcomes.
Programs must meet a number of criteria in order to be deemed “evidence-based.” Some important elements to consider are:
Quality of Program Design
Quality of Research Design
Evidence of Program Efficacy/Effectiveness
Capacity for Replication and Dissemination

11. Why Partner?
Approach a problem from multiple vantage points simultaneously
Implement comprehensive interventions
Coordinate services in the community
Combining different kinds of knowledge, skills, and resources allows partners to:
2) that connect multiple services, programs, policies, and sectors
3) (i.e., fill gaps, improve accessibility, reduce duplication of services, provide more efficient service)

12. Unique Combination of Strengths
This combination of strengths comes from the different areas of expertise of the national partners.
American Cancer Society (ACS)
provides a volunteer base and access to existing relationships with partners on a regional level.
recognition as a leading cancer organization provides credibility to efforts on a local level.
Centers for Disease Control
provides technical assistance, evaluation expertise and fiscal support to the project
supports screening and follow-up for screened women through the National Breast and Cervical Cancer Early Detection Program.
National Cancer Institute (NCI)
offers expertise in partnership and training via their Cancer Information Service’s Partnership Program and in program adaptation, planning, and evaluation via other NCI offices/divisions.
provides resources to identify evidence-based programs via Cancer Control Planet.
United States Department of Agriculture (USDA)
provides years of experience in reaching women who have not previously been reached with education and information for screening.
provides access to expertise in research and evaluation through their link to local University systems.

13. Unique Combination of Strengths
National networks and trained staff that cover the U.S, tribes, and territories
Technical and Content expertise
A variety of quality materials and publications
(networks) And reach all levels (regional, state, community)
(technical expertise) public education, outreach, cancer control planning, training, and evaluation
(content) in cancer, health, and nutrition
Tools and data, including Cancer Control Planet, CancerPlan.org, Community Health Profiles, Data (MDE, BRFSS)
Strategic locations and settings: cancer centers, state health departments, Land Grant universities, HBCU
History of reaching and screening women in need (1.75 million)
History of reaching the public (over 10 million calls)
History of reaching high risk populations

14. Looking Ahead
Identify benefits of partnering with different organizations and using evidence based approaches 
Determine most effective way to continue Team Up beyond the pilot
State teams will assist to determine if Team Up should continue in its current form, be expanded to other states, or be modified so that the partnership can adequately serve its intended audience.