1. Strategies for Eliminating Cervical Cancer: Recommendations for a Collaborative Approach Findings from the 2005 HPV & Cervical Cancer Summit Sarah Wells & Kathryn Guccione Women In Government Washington, DC November, 2006

2. In this paper, Women In Government recommends five strategies to guide policymakers, health advocates, federal and state agency representatives, the medical community and others in achieving the public health milestones necessary for eliminating cervical cancer. These recommendations are derived from Women In Government’s first annual Summit on HPV and Cervical Cancer and were guided by the following points of consideration: Purpose of Paper 1.How can stakeholders overcome racial and socioeconomic disparities to reach rarely and never-screened women? 2.How can new and emerging technologies be effectively incorporated into existing prevention programs? 3.How can we educate women about HPV, cervical cancer, and the need for prevention and screening? The following strategies and tactics reflect recommendations of Summit participants for reaching the goal of cervical cancer elimination

3. Worldwide, cervical cancer kills almost a quarter-million women each year. [i] [i] In the United States, cervical cancer rates have decreased significantly over the last 60 years due to widespread use of the Pap test. [ii] [ii] Despite this progress, in 2006, an estimated 9,710 women will be diagnosed with and 3,700 women will die of cervical cancer. [iii] Despite this progress, in 2006, an estimated 9,710 women will be diagnosed with and 3,700 women will die of cervical cancer. [iii] [iii] [i][i] Pan American Health Organization, “Preventing Cervical Cancer Worldwide,” World Health Organization accessed from, 27 Feb 2006. http://www.paho.org/common/Display.asp?Lang=E&RecID=8296 [i]http://www.paho.org/common/Display.asp?Lang=E&RecID=8296 [ii][ii] Devesa SS, DT Silverman, JL Young Jr, et al. “Cancer incidence and mortality trends among whites in the United States, 1947-84.” J. Natl. Cancer Inst. 1987;79:701-70. [ii] [iii][iii] American Cancer Society. Cancer Facts and Figures 2006. Atlanta, GA: American Cancer Society, 2006. [iii]Background

4. Reaching rarely or never screened women Studies have found economic, racial, and ethnic disparities in both cervical cancer incidence and mortality rates. Incorporating new and emerging technologies into prevention programs Conventional Pap smear & liquid-based cytology HPV testing HPV vaccine Educating women about HPV, cervical cancer, and opportunities for prevention Key Public Health Opportunities/Challenges

5. Women In Government has developed a framework to eliminate cervical cancer wherein stakeholders, regardless of their primary interests, can join forces to effect positive change Modeled after Women In Government’s first annual HPV & Cervical Cancer Summit in Atlanta, Georgia in November 2005. The Summit marked the largest cervical cancer meeting in the United States to date Participants included state legislators, public health advocates, medical experts, and state and federal agency representatives, including those from the Centers for Disease Control and Prevention (CDC) Participants included state legislators, public health advocates, medical experts, and state and federal agency representatives, including those from the Centers for Disease Control and Prevention (CDC) Participants included 33 state legislators, 35 state agency representatives, 38 representatives from advocacy groups, 19 members of federal agencies, and 11 businesses Participants included 33 state legislators, 35 state agency representatives, 38 representatives from advocacy groups, 19 members of federal agencies, and 11 businesses Participants represented 48 states and the District of Columbia. Participants represented 48 states and the District of Columbia.Methods

6. Strategy #1 Build coalitions among stakeholders to implement comprehensive cervical cancer elimination strategies, which include FDA-approved vaccines and screening to reach vulnerable populations. Recommended Strategies: Build Coalitions

7. Tactics for Coalition BuildingPARAGMC 1.Partner with state breast and cervical cancer early detection programs to disseminate educational information to constituents.  2.Partner with women’s clubs, sororities, advocacy groups, faith-based organizations and membership associations to use their expertise and outreach for reaching women.  3.Engage state employee health plans to disseminate educational information to employees and establish comprehensive health education in schools.  4. Collaborate with comprehensive cancer control plans to ensure that each state is addressing advances in cervical cancer prevention.  5. Encourage the State Children's Health Insurance Program (SCHIP) to disseminate information to parents about vaccination. 

8. Tactics for Coalition BuildingPARAGMC 6.Ensure funding for existing state Offices of Women’s Health and establish offices in states that do not have one.  7.Create funding for mobile screening programs.  8.Identify and recruit members of the medical community willing to perform volunteer screening services.  9.Cultivate financial support from local banks, chambers of commerce, and other community partners for outreach programs.  10.Partner with the private sector to fund outreach and educational activities.  11.Enlist the support of policymakers to support cervical cancer prevention efforts, funding and legislation. 

9. Tactics for Coalition BuildingPARAGMC 12.Disseminate disease and screening information to locations where women gather (e.g., hair and nail salons, schools, on public transportation, etc.).  13.Use opportunities with second generation daughters to educate immigrant mothers.  14.Enlist immigrant women leaders for outreach to vulnerable populations.  15.Assess what it would take to get rarely or never screened women screened by surveying vulnerable populations of women.  16.Go door-to-door in communities that are medically underserved.  17.Connect with religious communities and faith based organizations to educate and reach women with important healthcare messages. 

10. Strategy #2 Heighten awareness of HPV, cervical cancer, the need for screening, and potential benefits of vaccination. Recommended Strategies: Heighten Awareness

11. Tactics for AwarenessPARAGMC 1.Simplify messages regarding HPV and cervical cancer when speaking with constituents.  2.Focus educational outreach efforts on cervical cancer prevention and removing the stigma of HPV.  3.Utilize the media to mainstream educational messages for constituents and colleagues.  4.Create and execute public information campaigns through legislative action.  5.Create and disseminate educational brochures and other marketing materials. 

12. Tactics for AwarenessPARAGMC 6.Educate and empower women/constituents/patients to take responsibility of their own health.  7.Educate parents about the link between HPV and cervical cancer and the prevalence of the virus.  8.Partner with men to ensure they are educated about HPV and cervical cancer and supportive of women assessing screening services.  9.Educate the medical community by including the topics of HPV and cervical cancer in core curricula for medical and nursing schools and offer accredited continuing education programs on cervical cancer prevention for physicians, nurses, and other health educators. 

13. Strategy #3 Ensure reimbursement for and access to Pap testing, HPV testing, and HPV vaccination when available. Recommended Strategies: Ensure Reimbursement

14. Tactics for Reimbursement for ServicesPARAGMC 1.Provide legislative support for reimbursement (public and private, including Medicaid coverage) of screening services.  2.Advocate for and ensure that all patients have a medical “home.”  3.Work with states to address public funding of vaccines if approved by the FDA.  4.Coordinate efforts of legislators, department of health officials, and public health advocates to ensure the implementation of immunization programs for an HPV vaccine, in addition to continued collaboration to enhance current screening programs. 

15. Tactics for Reimbursement for ServicesPARAGMC 5. Establish medically advanced nursing practices, with physician oversight, especially in rural areas.  6. Create and work with physicians to ensure that screening and vaccination services are carried out as recommended by clinical practice guidelines.  7. Ensure flexibility in healthcare services (hours of operation, payment options, etc).  8. Coordinate collaborative meetings with insurance providers. 

16. Strategy #4 Create comfortable and supportive educational tools and screening environments. Recommended Strategies: Improve Education and Screening

17. Tactics for comfortable and supportive educational tools and screening environments PARAGMC 1.Disseminate information to women/constituents on how to track their own medical records and information.  2.Educate constituents/patients about having “health buddies” to build relationships and encourage women to obtain regular screening.  3.Ensure that informational materials are linguistically and culturally sensitive.  4.Establish patient navigation programs.  5.Strengthen refugee health programs to expand women’s health access.  6.Utilize peer-to-peer opportunities in medical and educational settings to avoid mistrust. 

18. Strategy #5 Improve data collection quality to evaluate programs and services Recommended Strategies: Improve Data Quality

19. Tactics for Improving Data Collection QualityPARAGMC 1.Create a state-specific inventory of cervical cancer prevention programs and stakeholders, including a speaker’s bureau for outreach efforts.  2.Work with state cancer registries, the CDC and state health departments to improve the quality of data collection among women receiving screening services.  3.Survey women to assess understanding of HPV and cervical cancer, Pap and HPV tests, and eventually, an HPV vaccine.  4.Measure vaccination and screening rates in each state to evaluate outcomes of educational campaigns. 

20. Women In Government has identified five priority strategies in order to reach the goal of cervical cancer elimination: Conclusion: Five Priority Strategies 1. 1.Build coalitions among all stakeholders. 2. 2.Heighten awareness of this disease, screening, and prevention technologies among all stakeholders. 3. 3.Improve financial support (reimbursement) for screening and vaccination. 4. 4.Create comfortable and supportive educational environments and materials for women. 5. 5.Evaluate data, programs and services.

21. Statement Re: Vaccines for Children Program: States should direct dedicated funding streams to support VFC Program infrastructure (e.g., administration, providers’ time, education, etc.), and state departments of health should develop and implement plans to ensure all girls and women aged 9 through 18 have access to and receive FDA-approved cervical cancer/HPV vaccines, with an emphasis on the routine vaccination of 11 and 12-year-old girls. Statement Re: School Entrance Requirements: States should require cervical cancer/HPV vaccination for girls to enter middle school, in conjunction with other adolescent vaccines required at this time, and should allow parents to opt out in accordance with states’ existing exemption allowances (e.g., medical, religious and/or philosophical). *These recommendations were developed by Women In Government’s national, bi-partisan Cervical Cancer & HPV Task Force in August 2006 Additional Women In Government Policy Recommendations*

22. Statement Re: Health Coverage: States should strongly encourage health plans to cover FDA- approved cervical cancer/HPV vaccines, Pap tests and HPV tests. Statement Re: Access for Uninsured/Underinsured Not Covered by VFC: States should require Medicaid to cover FDA-approved cervical cancer/HPV vaccines for eligible 19-26 year-old women. States should ensure that public health programs are adequately funded (e.g., state general funds, 317 funds, Title X, etc.) and utilized to ensure that all other uninsured or underinsured females aged 9 to 26 have access to cervical cancer/HPV vaccination. Additional Women In Government Policy Recommendations

23. Statement Re: Education & Awareness: Existing statewide entities focused on cancer prevention and/or health (e.g., statewide cervical cancer task forces, state health departments, women’s caucuses, etc.) should take the lead on developing and executing programs to educate and involve stakeholders (e.g., policymakers, providers, parents, young women, school administrators, etc.) about cervical cancer, HPV, and the role of available preventive technologies. Statement Re: Role of Statewide Accountable Entities: States should ensure that statewide cervical cancer task forces or other accountable entities are informed about and address new information and data about cervical cancer/HPV vaccines. States should consider that legislative action may be required to extend the parameters of task force timeline, members, etc. Additional Women In Government Policy Recommendations

24. Sarah Wells, Senior Director of Public Policy Email: swells@womeningovernment.org Kathryn Guccione, Senior Public Policy Associate Email: kguccione@womeningovernment.org Phone: 202-333-0825 Women In Government HPV & Cervical Cancer Policy Resource Center Toll-Free: 1-888-333-0164 Email: resourcecenter@womeningovernment.org Website: www.womeningovernment.org/prevention