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9. Federal Programs That Support Cancer Prevention and Early Detection
Pages 332-364

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From page 332... ... Previous chapters highlight the significant roles of state and local entities (both public and private) in carrying out important functions to incorporate cancer prevention and early detection programs into community-based programs (Chapters 4 and 6~. Read the entire page →
From page 333... ... The U.S. Preventive Services Task Force (USPSTF) Read the entire page →
From page 334... ... In the area of cancer prevention and early detection, recent statements are available for breast cancer screening for women ages 40 to 49 (1997) ,~ cervical cancer (1996) Read the entire page →
From page 335... ... . CONQUEST inclucles measures related to the management of several cancers (i.e., colorectal, lung, prostate, and breast cancer) Read the entire page →
From page 336... ... MONITORING AND SURVEILLANCE Several federally supported surveys and administrative record systems provide the data needed to assess progress toward reaching the nation's cancer prevention and early detection goals (Box 9.3~. The National Health Interview Survey (NHIS) Read the entire page →
From page 337... ... . State-based estimates of preventive health behaviors, knowledge, and attitudes are available through CDC's Behavioral Risk Factor Surveillance Read the entire page →
From page 338... ... , for example, uses both survey data and formal audits of medical records to assess progress in cancer prevention and early detection (see Tables 9.3 and 9.4~. FACILITATING STATEWIDE PROGRAM PLANNING AND EVALUATION National organizations may set guidelines and policy for cancer prevention and control, but implementation of public health measures to reduce the burden of cancer largely falls to state and local health departments, along with their partners, which include consumer and advocacy organizations, universities, and area health care providers. Read the entire page →
From page 339... ... . CDC has identified a useful framework for the establishment of a state cancer control program and has provided various models for comprehensive planning and evaluation. Read the entire page →
From page 340... ... State data on the prevalence of cancer-related risk factors such as smoking are available through the Behavioral Risk Factor Surveillance System (CDC, Division of Adult and Community Health, http://www. cdc.gov/nccUphp/briss/) Read the entire page →
From page 341... ... In 2002, for example, CDC had resources to support only half of the requests for assistance from states, territories, and Indian tribes in response to its National Cancer Prevention and Control Program Announcement (Leslie Given, Division of Cancer Prevention and Control, CDC, personal communication to Maria Hewitt, IOM, August 26, 2002~. The CDC estimates that $30 million per year would be needed before states would have plans developed and implementation in progress by 2005 (Leslie Given, Division of Cancer Prevention and Control, CDC, personal communication to Maria Hewitt, IOM, August 26, 2002~. Read the entire page →
From page 342... ... � Veterans Health Administration � Indian Health Service � Centers for Disease Control and Prevention (National Breast and Cervical Cancer Early Detection Program) � Office of Family Planning, US DHHS Indirect Providers of Services (PayersJ � Centers for Medicare and Medicaid Services (formerly the Health Care Financing Administration) Read the entire page →
From page 343... ... In 1998, HRSA-funded health centers served approximately 9 percent of Medicaid beneficiaries, 8 percent of uninsured Americans, and 20 to 25 percent of the poor and near-poor uninsured Americans (Health Resources and Services Administration, 2001; Institute of Medicine, 20003~. The majority of BPHC health center patients are from racial or ethnic minority groups (Health Resources and Services Administration, 2001~. Read the entire page →
From page 344... ... Health promotion and disease prevention practices within VHA are guided by formal recommendations established by the VHA National Center for Health Promotion and Disease Prevention (Veterans Health Administration, 1999~. Recommendations regarding counseling for cancer-related behavioral risk factors and cancer screening are summarized in Tables 9.1 and 9.2. Read the entire page →
From page 345... ... All veterans should have access to counseling regarding optimizing their level of physical activity. SOURCE: Veterans Health Administration (1999) Read the entire page →
From page 346... ... A comparison of some results regarding cancer-related prevention services from the 1999 chart audit and the veterans health survey shows somewhat higher rates of adherence to recommendations from the chart review than Read the entire page →
From page 347... ... b Year 2000a 1997 1998 1999 Tobacco use counseling � Men who are current tobacco users � Women who are current tobacco users � Men tobacco users offered counseling � Women tobacco users offered counseling 15 15 75 75 30 30 27 27 27 25 73 79 79 78 82 84 Problem drinking and alcohol moderation counseling � Men asked about/screened for problem 75 29 39 38 drinking and alcohol use this year � Women asked about/screened for problem 75 21 29 30 drinking and alcohol use this year Weight control and nutrition counseling � Men receiving nutrition counseling this year � Women receiving nutrition counseling this year Physical activity counseling � Men receiving activity counseling this year � Women receiving activity counseling this year Cervical cancer detection 75 75 50 50 � Women under age 65 with Pap test in past 85 3 years Breast cancer detection � Women ages 50 to 69 receiving a mammogram 60 85 in the past 2 years Colorectal cancer detections � Women over age 50 receiving a fecal occult blood test this year � Men over age 50 receiving a fecal occult blood test this year 49 45 50 48 57 60 61 55 58 59 89 89 87 87 86 50 33 56 61 50 29 51 55 aHealthy People 2000 goals as stated in VHA Handbook 1101.8. Weighted as appropriate; 95 percent confidence interval for VHA is less than +1 percent. Read the entire page →
From page 348... ... cancer screening Screening for colorectal cancer Mammography Cervical cancer Prostate cancer 95 93 49 69 74 91 94 66 SOURCE: VHA, 1999 Network Performance Report; Ron Sorrell, administrative officer, National Center for Health Promotion, personal communication, June 4, 2001. Top-performing programs for prevention services, identified through the chart audit program and veterans health survey, were contacted in 1999 to identify best practices to be shared across the program. Read the entire page →
From page 349... ... American Indians and Alaska Natives have historically had very low rates of cancer, in part because of competing causes of death (e.g., infectious diseases like tuberculosis) but, possibly, also because of their diets, physical activity patterns, and limited tobacco use. Read the entire page →
From page 350... ... Mammography within the past 2 years was reported by 65 percent of American Indian and Alaska Native women age 50 and older during the period from 1992 to 1997 in the Behavioral Risk Factor Surveillance System (Coughlin et al., 1999~. Studies of the rate of screening mammography use among selected groups of American Indian women Navajo Indian women (Strauss et al., 1997~; Sioux Indian women (Mahmoodian, 1997~; American Indian women in Albuquerque, New Mexico (Gilliland et al., 2000~; American Indian women in Phoenix, Arizona (Risendal et al., l999b) Read the entire page →
From page 351... ... . Very high rates of alcohol-related disease and injury, diabetes, and mental health conditions among American Indians and Alaska Natives may diminish the emphasis placed on cancer control among programs administered by tribal health directors (Michalek et al., 1996~. Read the entire page →
From page 352... ... . In addition to contraceptive services, Title X clinics provide basic reproductive health care such as screening for breast and cervical cancer; screening for sexually transmitted diseases including human immunodeficiency virus infection; and general health education, counseling, and referrals. Read the entire page →
From page 354... ... As of 1999 only 18 percent of Medicare beneficiaries were enrolled in managed care plans. Total outlays for Medicare benefit payments were $210.1 billion in 1998, representing an estimated 13 percent of the total federal budget (Health Care Financing Administration, 2000b) Read the entire page →
From page 355... ... General Accounting Office, 2000~. In 1999, the rates of use of colorectal cancer screening tests among beneficiaries age 50 and older were 9.1 percent for the fecal occult blood test, 1.9 percent for sigmoidoscopy, 1.9 percent for flexible sigmoidoscopy, and 3.8 percent for colonoscopy. Read the entire page →
From page 356... ... . no minimum age Fecal occult Individuals blood test age 50 and older Flexible Individuals sigmoidos- age 50 and copy older Barium enema None None 20 None None for lab, 20 for collection Every 2 years, annual for high-risk women Every 2 years, annual for high-risk women Annual 20 Yes None 20 None Annual None None Every 10 years, 20C Yes but not within 4 years of a screening flexible Annual None None Every 4 years 20C Yes Alternative to . Read the entire page →
From page 357... ... 357 Claims-Based Estimate 1997-1999 (Women Ages 52 to 69) a/ /o Rate in median state 70 56 Rate range 57-83 47-66 Alabama 76 (70-81) Read the entire page →
From page 358... ... Smoking Cessation Benefits Within the Medicare Program The rate of current smoking among Medicare beneficiaries age 65 and older varies markedly by state, with the range being from 3.7 percent in Utah to 20.6 in Nevada. Estimates of the share of smokers who have attempted to quit smoking range from 16.7 percent in Arizona to 59.3 percent in Alabama (Health Care Financing Administration, 2000a) Read the entire page →
From page 359... ... reimbursement for provider counseling and Food and Drug Administration-approved prescription or nicotine replacement pharmacotherapy, and 3. a telephone counseling quit line and reimbursement for nicotine replacement therapy. Read the entire page →
From page 360... ... Many variations exist among state Medicaid programs regarding not only which services are covered but also the amount, duration, and scope of services. Each state Medicaid program must cover "mandatory services" identified by statute and have the discretion to cover additional "optional services." Early and Periodic Screening, Diagnosis, and Treatment services are mandatory for individuals under age 21, whereas screening and prevention services are optional for older enrollees (Health Care Financing Administration, 20003~. Read the entire page →
From page 361... ... . Only half of the states, however, cover even one smoking cessation treatment for their Medicaid recipients, according to a review of Medicaid coverage for treatments for tobacco dependence in 1998 (Schauffler et al., 2001a) Read the entire page →
From page 362... ... 362 CANCER PREVENTION AND EARLY DETECTION TABLE 9.9 Medicaid Program Coverage of Pharmacotherapy and Counseling United States,a 2000 Over-the-counter Any medication Prescription Medication Prescripti~ State treatment Gum Patch Any Spray Inhaler Zyban Arizona fib Arkansas � CaliforniaC � � � ColoradoC � � � DelawareC � � � District of Columbia � Florida � � � Hawaii � IllinoisC � � � IndianaC � � � Kansas � � . Read the entire page →
From page 363... ... FEDERAL PROGRAMS Id 363 ication Prescription Medication Counseling Inhaler Zyban Wellbutrin Bupropion Any Group Individual Telephone � � ~ � � � � � � � � � � � � � � � � � � � � � � ~ ~ he he he � � � � � � � � � � � � � � � � � ~ � ~ ~ he he he he � � � � � � � � � � � � � � � � � � � � � � � � 31 29 27 13 10 13 61 57 53 26 20 26 Read the entire page →
From page 364... ... Federal safety net providers including Community and Migrant Health Centers and Title X family planning clinics are key to closing the gap in service use and, ultimately, in reducing the unequal burden of cancer observed among poor and disadvantaged populations. Although some federal programs are at the forefront of promoting effective cancer prevention and early detection interventions, there appears to be much room for improvement. Read the entire page →

From page 332...

... Previous chapters highlight the significant roles of state and local entities (both public and private) in carrying out important functions to incorporate cancer prevention and early detection programs into community-based programs (Chapters 4 and 6~.

9. Federal Programs That Support Cancer Prevention and Early Detection Pages 332-364

9. Federal Programs That Support Cancer Prevention and Early Detection
Pages 332-364