1. Program Services Branch Division of Cancer Prevention & Control Djenaba Joseph, MD, MPH Medical Director (Acting) National Center for Chronic Disease Prevention and Health Promotion

2. Program Service Branch  Program Services Branch (PSB) manages CDC’s two cancer screening programs: National Breast and Cervical Cancer Early Detection Program (NBCCEDP) Colorectal Cancer Control Program (CRCCP)

3. 1991-2009 and counting….

4. Breast and Cervical Mortality Prevention Act of 1990 Key Activities Specified  Breast and cervical cancer screening  Referrals, follow-up and support services  Public information and education  Professional education  Quality assurance  No funds for treatment  Evaluation Key Required Elements  60% of funds to be used for direct clinical services  40% for other activities  10% limit on administrative costs  State contributes $1 for every $3 US federal funds

5.  Women  Uninsured or underinsured for screening services  250% Federal Poverty Level or lower  Aged 18 – 64 for cervical cancer screening  Aged 40 – 64 for breast cancer screening  Women 65 and older typically covered by Medicare Target Population

6.  The Breast and Cervical Cancer Prevention and Treatment (BCCPT) Act of 2000 This Act gives states the option to provide treatment through Medicaid to women screened by the NBCCEDP and found to have breast or cervical cancer, including pre- cancerous conditions. Administered by CMS, not CDC State choice to participate or not (all states participate) State choice on BCCPT “options” which provide different levels of access to treatment through Medicaid  Native American Breast and Cervical Cancer Treatment Technical Amendment Act of 2001 This technical amendment to the BCCPT Act extends benefits of the BCCPT Act to American Indian and Alaska Native women. Cancer Treatment Resource

7. National Breast and Cervical Cancer Early Detection Program 1991 2009 CA ID OR WA MT WY UT CO NM TX OK KS NE SD ND MN WI IA IL OH IN KY WV VA NCNC GA FL AL MS MO AR LA NV MI PA NJ NY CT MA VT NH ME TN SCSC RI AZ DC DE MD HI REPUBLIC of PALAU AMERICAN SAMOA GUAM PUERTO RICO N MARIANA ISLANDS HI American Indian/Alaska Native Grantees Arctic Slope Native Assn, Ltd – Barrow, AK Cherokee Nation – Tahlequah, OK Cheyenne River Sioux Tribe – Eagle Butte, SD Kaw Nation – Kaw City, OK Native American Rehabilitation Assn Poarch Band of Creek Indians – Atmore, AL South Puget Intertribal – Shelton, WA Hopi Tribe – Kykotsmovi, AZ Navajo Nation – Window Rock, AZ Yukon-Kuskokwim Health Corp – Bethel, AK Southeast AK Regional Consortium – Sitka, AK Southcentral Foundation – Anchorage, AK 50 States, DC, 12 tribes/tribal orgs, & 5 US territories = 68 programs

8. Number of Women Screened, NBCCEDP Program Fiscal Years 1991-2008 Total Number of women ever screened = 3,253,285 Screened indicates that a woman received at least one Program Pap test, mammogram, or CBE in the fiscal year Program Year defined as July 1 thru June 30 Source: April 2008 Minimum Data Elements for screening through 12/31/07 paid with NBCCEDP funds

9. Number of Women Receiving Pap Tests, NBCCEDP Program Fiscal Years 1991-2008 Program Year defined as July 1 thru June 30 Source: October 2008 Minimum Data Elements for screening through 12/31/07 paid with NBCCEDP funds

10. Impact of the NBCCEDP  Between program years 1991 – 2008: >3.3 million women screened >8 million breast and/or cervical cancer screening examinations completed 37,117 breast cancers detected 121,500 pre-malignant cervical lesions & invasive cervical cancers detected

11. Colorectal Cancer Control Program (CRCCP)

12. Percentage of adults aged >50 years screened for colorectal cancer* -- Behavioral Risk Factor Surveillance System (BRFSS), United States, 2002, 2004, 2006, and 2008 2004 2002 2008 2006 *CRC screening = fecal occult blood test within past year and/or lower endoscopy in the preceding 10 years Did not participate In the survey 50.1%-60.0% 60.1%-70.0% ≥ 70.1%  50% UT NM TX OK NE IL I N KY WV AL MS MO AR LA TN HI MN MI FL GA SC VA NC OH PA NY WI KS ND IA CO CA OR WA NV AZ CT MA VT NH SD WY MT ID MD DE DC NJ AK ME RI

13. CRC Demonstration Screening Program  CDC designed CRC demonstration screening program To determine feasibility of establishing organized screening program for underserved population using federal funds To learn how best to implement CRC screening at community level To explore NBCCEDP model To inform current and future organized CRC screening efforts

14. CRC Demonstration Screening Sites 2005-2008

15. Colorectal Cancer Control Program - 2009 Arctic Slope Native Assn, Ltd – North Slope Borough, Barrow, AK Native Inupiat Eskimos Alaska Native Tribal Health Consortium, representing : Maniiliaq Association Norton Sound Health Corporation Chugachmuit Bristol Bay Area Health Corporation (BBAHC) Aleutian/Pribilof Islands Association (APIA) Kodiak Area Native Association (KANA) South East Alaska Regional Health Consortium (SEARHC) Ketchikan Indian Community (KIC) South Puget Intertribal Planning Agency – Shelton, WA Representing 7 tribes in southwest Washington May 2009 American Indian Initiative : CA ID OR WA MT WY UT CO NM TX OK KS NE SD ND MN WI IA IL OH IN KY WV VA NC GA FL AL MS MO AR LA NV MI PA NJ NY CT MA VT NH* ME TN SC RI AZ AK DC DE MD HI Southcentral Foundation, AK Cook Inlet regional Corp, Inc 22 States & 4 tribal organizations

16. Colorectal Cancer Control Program Two broad functions that are parallel, but separate tracks in terms of program development and evaluation planning: Providing CRC screening to low-income, un- and under- insured men and women Promoting CRC to all persons, insured and uninsured who are aged 50 and older for whom CRC screening is recommended Both contribute to achieving our program goal to increase CRC screening rates to 80% at the population- level by 2014

17. Providing CRC Screening Direct service delivery of CRC screening and diagnostic services to target population: –Men and women aged 50 – 64 years –Underinsured or uninsured for screening services –250% Federal Poverty Level or lower

18. Promoting CRC Screening Implementation of activities aimed to increase population-level screening rates: –Policy –Health Systems –Health Care Providers –Public Awareness and Education –Strategic Partnerships –Communities

19. Evaluation Planning Providing CRC Screening –Clinical data collection (CCDEs) –Cost data collection (PRD, CAT) Promoting CRC Screening - current CDC efforts: –Develop program framework and logic models –Develop implementation evaluation and outcome measures –Incorporate relevant activities into cost evaluation (CAT)

20. NBCCEDP http://www.cdc.gov/cancer/nbccedp/ CRCCP http://www.cdc.gov/cancer/crccp/ For additional information…

21. Thank You! The findings and conclusions in this presentation are those of the presenter and do not necessarily represent the views of the Centers for Disease Control and Prevention.

22. Breast and Cervical Mortality Prevention Act of 1990 (PL101-354) Law includes:  Breast and cervical cancer screening  Referrals, follow-up and support services including case management  Public information and education  Professional education  Quality assurance  No funds for treatment  Evaluation Program Reauthorization:  National Breast and Cervical Cancer Early Detection Program Reauthorization Act signed by President Bush on April 20, 2007  Reauthorizes the NBCCEDP for another 5 years: FY2007-FY2012  60/40 waiver pilot project

23.  The Breast and Cervical Cancer Prevention and Treatment (BCCPT) Act of 2000  Native American Breast and Cervical Cancer Treatment Technical Amendment Act of 2001 Cancer Treatment Resource Through Medicaid Program