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Breast Cancer Screening

Once a company has conducted assessment and planning for breast cancer screeningScreening means checking your body for cancer before there are signs or symptoms of the disease. The routine performance of screening tests may find many kinds of cancer early, when treatment is likely to work best. programs, and developed the specific tasks of implementation for these programs, it is time to develop the evaluation plan. This evaluation plan should be in place before any program implementation has begun.  

Metrics for worker productivity, health care costs, heath outcomes, and organizational change allow measurement of the beginning (baseline), middle (process), and results (outcome) of workplace health programs. It is not necessary to use all these metrics for evaluating programs. Some information may be difficult or costly to collect, or may not fit the operational structure of a company. These lists are only suggested approaches that may be useful in designing an evaluation plan.

These measures are designed for employee group assessment. They are not intended for examining an individual’s progress over time, which would raise concerns of employee confidentiality. For employer purposes, individual-level measures should be collected anonymously and only reported (typically by a third party administrator) in the aggregate, because the company’s major concerns are overall changes in productivity, health care costs, and employee satisfaction.

In general, data from the previous 12 months will provide sufficient baseline information and can be used in establishing the program goals and objectives in the planning phase, and in assessing progress toward goals in the evaluation phase. Ongoing measurements every 6 to 12 months after programs begin are usually appropriate measurement intervals, but measurement timing should be adapted to the expectations of the specific program. 

Mammography screening is a valuable early detection tool that can identify breast cancer at an early stage when treatment is more effective and less expensive.

  • In 2007, 202,964 women were diagnosed with breast cancer, and 40,598 women died as a result of breast cancer1
  • Women aged 40 to 64 years accounted for 61% of in situ cases, 54% of invasive breast cancer cases, and 40% of breast cancer deaths in 2005.2 The direct medical care costs for breast cancer treatment were estimated to exceed $6 billion in 19963

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Worker productivity measures for breast cancer screening4-13

Healthier employees are less likely to call in sick. Companies can sometimes assess sick day use to determine whether health programs are increasing worker productivity. 

There is some evidence that women who receive false positive results (when a mammogram is judged to have positive findings of abnormalities when the true result is negative) for screening mammograms have an increased risk of anxiety and depression.4 This experience may affect productivity, and appropriate psychological support for these women should be available.

Baseline

Process

  • Re-assess the average number of sick days per employee at the first follow-up evaluation
    • If employee education programs are successful, these measures may increase in the short term as screening and detection rates increase
  • Periodic repeats of other baseline measures

Outcome

  • Assess changes in the average number of sick days per employee in repeated follow-up evaluations
  • Assess changes in costs from baseline

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Health care costs measures for breast cancer screening5-9

In contrast with the worker productivity costs described above, health care costs are measures of the direct medical expenses of providing employee health care and preventive health programs.

Baseline

  • Determine costs and use for health care such as outpatient visits, screening, diagnostic procedures (e.g., biopsies), one-on-one education counseling, hospitalizations, and treatment (e.g., surgery or chemotherapy) for breast cancer related illness and disability
  • Determine the health care use and costs of program participants before education and other programs are initiated and after operation of these programs

Process

  • Periodic repeats of baseline measures

Outcome

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Health outcomes measures for breast cancer screening5-9,14-19

The effectiveness of breast cancer screeningScreening means checking your body for cancer before there are signs or symptoms of the disease. The routine performance of screening tests may find many kinds of cancer early, when treatment is likely to work best. programs depends on the intensity of program effort and the use of multiple interventions. A rule of thumb is that the more programs implemented together as a package or campaign, the more successful the interventions will be.

Baseline

Process

  • Periodic repeats of baseline measures

Outcome

  • Assess changes in levels of employee breast cancer screening rates such as:
    • Increases in the number of employees screened
    • Changes in the percentage of employees reaching breast cancer screening guidelines
  • Assess changes in the percentage of employees with health behaviors or conditions where individuals have a higher risk associated with breast cancer such as being overweight/obese (increases risk for breast cancer after menopause); drinking alcohol (more than one drink a day); using birth control pills (oral contraceptives), or being physically inactive5-10
  • Determine changes in the levels of diagnostic and treatment procedures from health and pharmaceutical claims data
  • Assess changes in employee knowledge, attitudes, and beliefs about breast cancer prevention and screening
    • Evaluate changes in employee knowledge of current breast cancer screening health benefits and guidelines
    • Measure changes in employee’s knowledge of their risks for breast cancer
    • Assess changes in employee awareness of existing workplace breast cancer screening programs, policies, and benefits
    • Assess changes in employee awareness of behaviors that may reduce breast cancer risk

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Organizational change measures for breast cancer screening5-9

Breast cancer screeningScreening means checking your body for cancer before there are signs or symptoms of the disease. The routine performance of screening tests may find many kinds of cancer early, when treatment is likely to work best. and clinical follow-up requires ongoing support from employers. New programs can be added over time and evaluated periodically for their effectiveness. For best results, recognition of the benefits of breast cancer screening should become an inherent part of organizational change and corporate culture.

Measuring organization change is an assessment of company-initiated programs and policies that affect most employees regardless of their health status (e.g., mobile mammography vans). These efforts need to be integrated for greatest effectiveness and will require time for full implementation. Regular measures of employee attitudes and program development are key in determining whether new programs are effective or require further adaptation to prevent continuing investment in ineffective efforts.

Baseline

  • Determine workplace barriers to employee’s engagement in breast cancer screening
  • Assess current workplace breast cancer prevention and screening programs
    • List current breast cancer screening options for employees through worksite and identify number of employees (i.e., participation) using each option. Examples:
      • Number of breast cancer screening programs (e.g., education seminars, individual education) and participation in these programs
      • Availability of educational materials on breast cancer screening
      • Number of communications/media campaigns regarding breast cancer screening. Examples:
        • Percentage of women receiving a telephone call (or a reminder) to obtain a mammogram among:
          • Women due or overdue for a mammogram
          • Women turning age 50 years
          • Women 50 years and older who are new health plan members
        • Percentage of women who scheduled a mammogram appointment during a telephone reminder call
      • Number of breast cancer prevention and screening related policies
      • Number of environmental strategies to reduce structural barriers
      • Number of partnerships with community resources for breast cancer screening such as the American Cancer Society or a local health department
    • Determine costs of current company breast cancer screening programs such as:
      • Staffing, equipment, and space
      • Employee time to participate in breast cancer screening programs during work hours (e.g., education or mobile mammography)
      • Reimbursements and subsidies for breast cancer screening to reduce out-of-pocket costs and structural barriers, such as classes, counseling, reducing co-payments, or transportation (see implementation for health benefits examples)
      • Incentives tied to breast cancer screening programs
      • Contracts with mobile mammography providers
    • Conduct survey of employee satisfaction with current workplace supported breast cancer screening programs

Process

  • Reassess barriers to employee engagement in breast cancer screening programs
  • Document steps taken and progress toward implementing each intervention selected
    • List numeric goals (e.g., desired increases in employee screening rates) in each form of intervention within a designated time period (e.g., 12 months from startup):
      • Employee reach (e.g., number of educational pamphlets distributed; number of employee reminders sent)
      • Employee participation (e.g., number of desired participants in breast cancer screening; number of mammogram appointments scheduled; number of mammograms delivered; number of one-on-one education sessions conducted)
    • Describe timeline for implementation of each planned intervention (e.g., length of time and timing of tasks to develop, initiate, and conduct a mass campaign)
    • Create a baseline budget for new interventions including classes, instructors, classroom space, materials, incentives, mobile mammography contracts, etc
    • Identify opportunities for new partnerships with community groups who provide breast cancer screening programs (e.g., The American Cancer Society, local health department, local hospital, etc.)
  • Reassess employee satisfaction regarding workplace supported breast cancer screening programs

Outcome

  • Measure reductions in the number and type of employee barriers to breast cancer screening
  • Assess changes in workplace breast cancer prevention and screening programs including progress in achieving goals and in implementation of each intervention (e.g., length of time and timing of tasks to develop, initiate, and conduct a mass campaign)
    • Measure changes in the number of breast cancer screening options for employees through the worksite and changes in employee participation using each option before and after the breast cancer screening program or campaign. Examples:
      • Number of new programs developed and offered to employees
        • Measure attendance (e.g., number of mammograms delivered) at onsite mobile mammography screening programs
        • Number of employees identified as recommended for breast cancer screening who have been sent a reminder for screening
        • Number of employees sent reminder who actually scheduled a mammogram and received the screening
      • Number of new educational materials developed and made available to employees
      • Number of new workplace communications/media campaigns, including posters, brochures,  etc., established
        • Was there an increase in mammogram appointments directly following an informational or awareness campaign
        • What was the percentage increase in mammogram appointments
      • Number of new workplace policies regarding breast cancer screening developed and implemented compared to baseline
      • Number of new environmental strategies to reduce structural barriers developed and implemented compared to baseline
      • Number of new partnerships with community groups created to enhance access and opportunity for employee breast cancer screening
    • Assess changes in program costs from baseline
      • Increases in staffing or equipment needs due to new program offerings
      • Changes in employee participation time during work hours (e.g., education or mobile mammography)
      • Changes in reimbursement/subsidy for breast cancer screening to reduce out-of-pocket costs and structural barriers such as classes, counseling, reducing co-payments, or transportation
      • New incentives or benefits or changes in existing incentives or benefits based on employee participation
      • New contracts with mobile mammography providers
    • Assess changes in survey responses for employee satisfaction following implementation of a workplace supported breast cancer screening program and compare with baseline

Depending on goal success, evaluate the need to adjust workplace programs.

Tools and Resources

Breast Cancer Screening Baseline Measures

The assessment tools described in the assessment module include specific questions related to breast cancer screening.

  Health-related Programs

  • Q11; Q12; Q20h; Q21c; Q22; Q23; Q24a,b,d,e,h,i; Q26; Q27; Optional Questions A, B, I, J, K, M, JJ, OO

  Health-related Policies

  • Q28a

  Health Benefits

  • Q29; Q30; Q31; Q32; Q33; Q36; Q37; Optional Questions T, V, W, Z

  Environmental Support

  • Q39; Q40; Q41; Q47; Optional Questions CC, LL

Additional Tools

  • In addition to the following suggestions for measures of worker productivity, health care costs, health outcomes, and organization change in colorectal cancer screening programs, see measurement recommendations for obesity, physical activity, nutrition, and tobacco use
  • The CEO Roundtable on Cancer, Inc. sponsors the CEO Cancer Gold Standard which provides accreditation for any company that demonstrates it has met all criteria for the Gold Standard
  • Health Risk Appraisals at the Worksite: Basics for HRA Decision Making [PDF - 2.3MB] is a guide developed by the National Business Coalition on Health in collaboration with the Centers for Disease Control and Prevention (CDC) in the selection and use of health risk appraisals in the workplace available for employers
  • The CDC Healthy Communities Program developed the Community Health Assessment aNd Group Evaluation (CHANGE) assessment tool to provide communities with a picture of the policy, systems, and environmental change strategies currently in place throughout the community, where gaps exists and facilitate action planning for making improvements. The CHANGE tool address five community sectors including worksites and health indicators related to physical activity, nutrition, tobacco use, chronic disease management, and leadership

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