VII. Chronic Disease Prevention

FY 2000 Performance Plan - Revised Final FY 1999 Performance Plan

Breast and Cervical Cancer Prevention

Breast and cervical cancer will kill more than one-half million women in this decade. Breast cancer accounts for nearly one-third of all cancers in women, and approximately 14,500 new cases of cervical cancer are diagnosed each year. Almost all deaths from cervical cancer and an estimated 30 percent of deaths from breast cancer in women over age 50 are preventable through widespread use of Papanicolaou (Pap) testing and screening mammography. A combination of annual clinical breast examinations and mammography can reduce breast cancer mortality by more than 30 percent for women age 50-74. Early detection also increases the 5-year survival rate to 91 percent. Early diagnosis of breast and cervical cancer saves money as well as lives. The cost of medical care for a woman whose breast cancer is diagnosed early may be two-thirds lower than the medical care cost for a woman whose cancer is diagnosed at a later stage.

CDC's National Breast and Cervical Cancer Early Detection Program (NBCCEDP) provides cancer screening for under-served women, particularly low-income women, older women, and members of racial/ethnic minorities. This program creates the foundation for an aggressive response to this health problem and ensures the delivery of successful screening services. CDC supports activities at the state and national level in the areas of screening referral and follow-up services, quality assurance, public and provider education, surveillance, collaboration and partnership development.

The ability to implement a nationwide program depends on the involvement of partners in national, state and local governments; health care professions and organizations; social service and advocacy organizations; and academia. Partnerships assist private and public nonprofit organizations to develop, implement, and evaluate national, community-based interventions for cancer prevention and early detection. They also test new methods and replicate already-proven strategies to educate their constituents about the prevention, early detection and control of cancers; increase access to screening among underserved populations; and create new collaborations with state health departments and others to enhance efforts for cancer control in priority populations. CDC funds a STRONGand effective network of partners that are well positioned in communities at risk and that bring critical knowledge, skills, credibility, and resources to CDC's cancer control efforts among priority populations. Such populations include the uninsured and such minority groups as American Indians, Alaskan Natives, African-Americans, Hispanics, Asian/Pacific Islanders, Lesbians, women with disabilities, and those who live in hard-to-reach communities in urban and rural areas.

Both performance measures submitted for the NBCCEDP are outcome measures. The measures are ambitious in view of the fact that with current resources, the NBCCEDP is able to reach about 12 percent of the eligible population. Additionally, the goal of any chronic disease screening program for chronic disease is to monitor health/disease status over time and detect disease early in its progression. Substantial positive increases in percentage cannot be expected annually among the relatively small portion of the nation's population served. By its nature, such a screening program will not show a large impact annually. Data collection for these measures has been systematized by the NBCCEDP, and state health agencies were involved in the development of these measures.

Performance Goals and Measures

Performance Goal: Increase early detection of breast and cervical cancer by building nationwide programs in breast and cervical cancer prevention.

Performance Measures:

FY Baseline	FY 1999 Appropriated	FY 2000 Estimate
64% (1995).	Excluding breast cancers diagnosed on an initial screen in the NBCCEDP, at least 67% of women aged 40 and older will be diagnosed at localized stage.	Excluding breast cancers diagnosed on an initial screen in the NBCCEDP, at least 67% of women aged 40 and older will be diagnosed at localized stage.
26 per 100,000 Pap Tests (9-30-95).	Excluding invasive cervical cancers diagnosed on an initial screen in the NBCCEDP, the age adjusted rate of invasive cervical cancer in women aged 20 and older is not more than 24 per 100,000 Pap tests provided.	Excluding invasive cervical cancers diagnosed on an initial screen in the NBCCEDP, the age adjusted rate of invasive cervical cancer in women aged 20 and older is not more than 24 per 100,000 Pap tests provided.
Total Program Funding	$159,071	$159,071

Verification/Validation of Performance Measures: CDC requires certain data elements related to breast and cervical cancer to be regularly reported by the states. These Minimum Data Elements (MDEs) are a set of standardized data elements developed to monitor and ensure that women receive the appropriate and timely screening, diagnostic, and treatment services needed. Funded states, territories, and tribes collect data on each woman served, and the MDEs are voluntarily submitted to CDC via contractor twice a year. Final data for the previous fiscal year are available in early April each year.

Links to DHHS Strategic Plan

In the DHHS Strategic Plan, Strategic Objective 4.1 states " Promote the appropriate use of effective health services," and it includes as a measure of success "Rates of increase in age-appropriate mammography screening." Additionally, Strategic Objective 4.2 states "Reduce disparities in the receipt of quality health care services," and a measure of success for this objective is " Disparities in breast and cervical cancer screening and management." Thus, increasing rates of breast and cervical cancer screening, particularly among population groups with poorer screening rates, is a priority stated in the DHHS Strategic Plan and implemented by CDC's National Breast and Cervical Cancer Early Detection Program.

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