State Cancer Programs in Action

National Breast and Cervical Cancer Early Detection Program (NBCCEDP)

Since 1991, the NBCCEDP has provided screening and diagnostic exams for breast and cervical cancer to low-income women with little or no health insurance. The NBCCEDP supports early detection programs in all 50 states, the District of Columbia, 12 American Indian/Alaska Native organizations, and 5 U.S. territories.

Mississippi Breast and Cervical Cancer Program
Reducing Breast Cancer Disparities Through Faith-Based Partnership and Training

Based on findings that African American women tend to have higher breast cancer death rates than other racial and ethnic groups, the Mississippi Breast and Cervical Cancer Program (MBCCP) found a way to inform African American women about their program. Because spirituality and religion are important components in understanding health and health-seeking behaviors within the African American community, the MBCCP built partnerships with faith-based organizations with the goal of educating African American women about breast cancer risk and early detection. Women 40 to 64 years old who were uninsured or underinsured were targets for the MBCCP's faith-based outreach activities.

To advance their faith-based partnership goal, in 2009, the MBCCP developed Praises in Pink. This train-the-trainer program engages faith-based liaisons statewide to organize breast cancer outreach activities at their houses of worship to educate parishioners about the importance of screening and inform them about MBCCP services.

The MBCCP worked with partners at the state and community level to recruit organizations from various faiths to participate in the program. Faith-based organizations across the state received recruitment letters asking them to conduct outreach activities during the month of October (Breast Cancer Awareness Month) to raise awareness.

Each faith-based organization was asked to identify a liaison to serve as a Praises in Pink representative within their congregation. Several of these liaisons were breast cancer survivors. MBCCP staff trained each liaison and provided him or her with a training curriculum, resource guides, an MBCCP provider list, health education materials, and memorabilia. Each organization and liaison committed to hosting at least one education and outreach program within their faith-based organization or community.

In its first year, 117 liaisons representing 85 houses of worship throughout the state participated in the Praises in Pink program, reaching 4,600 women. By October 2010, 213 liaisons had been trained and 140 organizations had joined the effort. That year, 7,000 women were informed about breast cancer screening and early detection through Praises in Pink. With the addition of 24 trained liaisons in October 2011, the MBCCP believes that many women in the target population received information on breast cancer prevention and related services—making this another successful year for Praises in Pink.

National Comprehensive Cancer Control Program

The NCCCP funds states, tribal organizations, and territories to establish coalitions, assess the burden of cancer, determine priorities, and develop and implement Comprehensive Cancer Control (CCC) programs. CCC is an integrated and coordinated approach to reducing cancer incidence, morbidity, and mortality through prevention, early detection, treatment, rehabilitation, and palliation.

Alabama Department of Public Health's Comprehensive Cancer Control Program
"Third Time's the Charm" HPV Vaccine Campaign

Human papillomavirus (HPV) is a troublesome virus known to cause genital warts and several types of cancer in both men and women. The virus, which is spread through sexual contact, is the leading cause of cervical cancer in women, with roughly 12,000 cases reported each year. Cervical cancer is responsible for the deaths of about 4,000 U.S. women each year. Yet only half of teenage girls in the U.S. have taken the vaccine, although it is readily available.

In 2011, the Alabama Department of Public Health's (ADPH) Comprehensive Cancer Control Program joined with the ADPH Breast and Cervical Cancer Early Detection Program to develop a campaign promoting HPV vaccination. The "Third Time's the Charm" campaign targets Alabama parents, pediatricians, and college students with a message that emphasizes the importance of getting all three doses of the HPV vaccine. Parents and pediatricians are urged to begin the vaccinations at age 11, when it can be paired with the vaccine against tetanus, diphtheria, and pertussis (whooping cough), which all children in Alabama are required to receive at that age. College students are reminded that under health care reform, the vaccines may be covered under their parents' insurance. Campaign materials included postcards, posters, and a 30-second commercial which ran in Alabama movie theaters throughout the summer. These materials were adapted for print advertisements running in statewide parenting magazines, as well as a journal for primary care physicians in the state.

After this initial push, both programs have fielded several opportunities to expand the campaign into new formats.

The ADPH Immunization Department is sending birthday cards with reminders about the HPV vaccine to Alabama girls on their 11th and 12th birthdays.
Campaign materials have been expanded to include signs placed on gas pumps throughout Alabama and a small bracelet charm that will be packaged with HPV educational materials and distributed on college campuses.
REACH U.S., a program created by CDC to eliminate racial and ethnic disparities in health care, inquired about using teen educators to speak to peers about the HPV virus and vaccine.
The Alabama Medicaid Agency runs a "Third Time's the Charm" advertisement in their magazine, and uses the magazine to educate doctors on the importance of the vaccine.

The "Third Time's the Charm" campaign has proven effective in educating residents about the importance of girls getting all three doses of the HPV vaccine. We expect the campaign to help increase HPV vaccination rates in the coming years.

National Program of Cancer Registries (NPCR)

The NPCR collects data on cancer occurrence; the type, extent, and location of cancers; and the type of initial treatment. The NPCR supports central cancer registries in 45 states, the District of Columbia, Puerto Rico, and U.S. Pacific Island jurisdictions.

Maine Cancer Registry
Registry Data Show the Value of Colorectal Screening

For several years, the Maine Cancer Consortium has used data from the Maine Cancer Registry and CDC's Behavioral Risk Factor Surveillance System (BRFSS) to inform and motivate cancer programs, state policy makers, funders, and citizens.

The registry reviewed the diagnosis data four times between 1995 and 2005 to find out at what stage the colorectal cancers were at the time of diagnosis. Over the 10-year period—

The percentage of colorectal cancer cases in the most treatable local stage increased steadily.
The percentage of colorectal cancer cases diagnosed in a regional stage decreased steadily.
The percentage of colorectal cancer cases diagnosed at the distant stage did not change.

During this same time frame, the rates of colorectal cancer deaths declined in Maine. BRFSS data showed that the number of Maine adults aged 50 years and older who reported ever getting a sigmoidoscopy or colonoscopy rose from 42% in 1999 to 62% in 2005.

By 2004–2005, 47% of colorectal cancers in Maine were localized at diagnosis compared with 40% for the U.S. population, which shows a direct relationship between stage at diagnosis and survival.

Maine Cancer Registry data were used in Maine's successful application to CDC for funding to implement colorectal cancer screening opportunities for low-income and uninsured residents throughout the state. The data helped identify the regions and counties where incidence or death rates are highest, suggesting where the comprehensive cancer control and colorectal cancer screening programs might focus their efforts.

Colorectal Cancer Control Program (CRCCP)

Photo: A man with his healthcare professional

Launched in 2009, the CRCCP provides funding to 25 states and 4 tribes across the United States to increase colorectal (colon) cancer screening rates among men and women aged 50 years and older. An increase in screening rates will reduce illness and death from colorectal cancer.

Pennsylvania Colorectal Cancer Control Program
Partnering to Inform the Insured Population

To learn about the information and resources needed to increase colorectal screening in the community, the Pennsylvania Colorectal Cancer Control Program (PA CRCCP) conducted an environmental assessment of worksites and health care insurers. The program surveyed selected Pennsylvania employers to find out—

How many employers provide health insurance that covers colorectal cancer screening.
How many employees take advantage of the screening coverage.
The availability of screening support services, including educational materials and policies supporting screening.
If employers would like the PA CRCCP to provide free online or health educator-facilitated colorectal cancer education to their employees.

The Pennsylvania program has had success forming strategic partnerships to promote wellness in the workplace. In 2009, Pennsylvania partnered with General Electric (GE) Transportation in Erie, Pennsylvania, to increase colorectal cancer screening rates. GE Transportation is one of the largest companies in northwestern Pennsylvania, with more than 7,000 employees. GE also has a robust global wellness plan for employees.

Before partnering with the Pennsylvania Department of Health (PA DOH), GE Transportation employees' colorectal cancer screening rates were low, even though GE provided free screenings. To help increase the screening rate, trained health educators from the PA CRCCP joined GE Transportation safety educators for monthly safety meetings. After about four months of collaboration, more than 800 employees had participated in the 45-minute group colorectal cancer education sessions. GE Transportation employees' colorectal cancer screening rate increased 4%.

In 2011, to address funding and personnel constraints that limited provision of these services, PA CRCCP collaborated with the Drexel University School of Public Health to develop an online colorectal cancer education module, which is being piloted at GE Transportation. The module is a more concise version of the face-to-face education session, and includes a video that informs participants of risk factors and causes of colorectal cancer, explains various screening tests, and showcases survivors' personal experiences.

Participants take pre- and post-tests to measure demographics, lifestyle, perception of colorectal cancer, screening adherence, and intention to be screened. The Drexel University School of Public Health will evaluate the impact of the colorectal cancer education module on employee screening prevalence, the implementation process, and user experience. The PA CRCCP will continue to work with GE, so that this model for successful collaboration can be replicated in other divisions of the company.