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Breast Cancer Screening
Once assessment and planning have been completed, including analysis of the collected data, the next step is implementing the strategies and interventions that will comprise the workplace health program. The intervention descriptions on this page include the public health evidence-baseThe development, implementation, and evaluation of effective programs and policies in public health through application of principles of scientific reasoning, including systematic uses of data and information systems, and appropriate use of behavioral science theory and program planning models. for each intervention, details on designing interventions for breast cancer screening, and links to examples and resources.
Multi-component interventions that include communications/media, education, reduction of barriers, and enhanced access to care will increase employees’ awareness of and participation in screening, prevention, and treatment.
Before implementing any interventions, the evaluation plan should also be developed. Potential baseline, process, health outcomes, and organizational change measures for these programs are listed under evaluation of breast cancer screening programs.
Breast cancer is the second most common cause of cancer deaths among adult women.
- 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
The United States Preventive Services Task Force recommends:
- Women aged 50-74 years should receive 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. mammography, with or without clinical breast examination, every 2 years. 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
- For women younger than 50 years of age, the decision to start mammography screening should be made in consultation with their physician and take into consideration such factors as family history and general health
- Women whose family history is associated with an increased risk of "breast cancer genes (mutations in BRCA1 or BRCA2 genes)" should be referred for genetic counseling and evaluation for BRCA testing
- Against routine referral for genetic counseling or routine breast cancer susceptibility gene (BRCA) testing for women whose family history is not associated with an increased risk for breast cancer genes
- Clinicians should discuss chemopreventive medications, such as tamoxifen, with women at high risk for breast cancer and at low risk for adverse effects of preventive medication use
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. mammography refers to mammography used as part of a regular preventive services plan and not to mammograms used to follow up on abnormal radiologic or physical findings. The U.S. Preventive Services Task Force (USPSTF) recommends screening mammography, with or without clinical breast examination (CBE), every 2 years for women aged 50-74 years.
In Rankings of Preventable Services for the U.S. Population, the Partnership for Prevention provides an approach to ranking preventive services according to their clinically preventable burden (CPB) and cost effectiveness (CE). CPB is the disease, injury and premature death that would be prevented if the service were delivered to all people in the target population. With this approach, mammography screening received a ranking of 6 on a scale of 1-10, with 10 the highest ranking.
Employee programs refer to activities that include active employee involvement, such as classes, seminars or competitions. Employee programs are frequently provided on-site at the workplace.
Employee health surveys in the workplace provide assessment and implementation opportunities
- Information from employee health surveys can be used to identify the percent of women employees that have received appropriately timed 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.. Women who are in the appropriate age group and have not received screening should receive screening education and information on employee health benefits related to screenings
One-on-one patient education is recommended to increase mammography screening
- One-on-one education is defined as communication of information to individual clients by telephone or through face-to-face encounters, conducted by a health care or allied health professional (e.g., health educator) or by a lay health advisor or volunteer
- The education sessions can occur in clinical settings, homes, or worksites
- The education content can address a general target population or be tailored to the unique circumstances and characteristics of specific individuals that are identified through individual assessments
- One-on-one education can be supplemented by the use of:
- Informational letters, or
- Reminders (printed or telephone)
Worksite-wide education campaigns increase use of screening services
- Improving communications about the availability and coverage of preventive services is recommended to increase their use. For example, flyers or brochures about the screenings could be placed in employee break rooms and on bulletin boards. Additional strategies to consider include mailing information and reminders to employees’ homes and company-wide e-mails to employees
- The Task Force on Community Preventive Services reports that use of cancer screening services increases when employees receive consistent communication and reminders about 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.
- Workplace screening programs may include mobile mammography vans that come to the worksite or to a nearby site and provide on-the-spot screening for women. Mobile mammography services are often available from hospitals and other clinical centers. These services offer convenience, less time away from work, and support from fellow workers to attend screening programs together
- Bringing mobile screening services on-site is often an effective strategy to reduce out-of-pocket expenses. In addition, an on-site mobile screening service can help reduce structural barriers that keep many women from getting regular mammograms. On-site interventions such as these reduce the access barriers that prevent employees from receiving preventive services such as location of a screening facility, its hours of operation, and the availability of child care
Address obesity and alcohol use as additional risk factors for breast cancer
- The health-related program strategies and interventions listed for physical activity, nutrition, obesity, and alcohol misuse include lifestyle activities recommended to reduce breast cancer risk
Tools and Resources (more)
- Breast Cancer Web site developed by the Centers for Disease Control and Prevention (CDC) for consumers
- The Partnership for Prevention’s Investing in Health: Evidence-Based Health Promotion Practices for the Workplace describes multiple workplace programs to encourage cancer screening, including speaking events, reminders, flyers, and other approaches. This booklet can be downloaded from the website or ordered
- The local chapter of the American Cancer Society (ACS) may offer educational programs, brochures, and other services. Chapter locations are listed on the ACS website
Workplace policies promote a corporate “culture of good healthThe creation of a working environment where employee health and safety is valued, supported and promoted through workplace health programs, policies, benefits, and environmental supports. Building a Culture of Health involves all levels of the organization and establishes the workplace health program as a routine part of business operations aligned with overall business goals. The results of this culture change include engaged and empowered employees, an impact on health care costs, and improved worker productivity..”
Providing sick leave or flextime for women who need screening or clinical follow-up will reduce structural barriers
- Flexible times for beginning and ending work each day, or "flextimeAllow employees to shift their work schedules, such as coming in earlier or later or taking a lunch break at alternate times. Flextime can be useful in creating opportunities for employees to engage in health promotion activities such as physical activity during the day and yet maintain their expected number of work hours. " policies can be useful in creating opportunities for employees to schedule/arrange for a screening during the day yet maintain their expected number of work hours. Flextime policies allow employees to shift their work schedules, such as coming in earlier or later or taking a lunch break at alternate times
Health benefits to support breast cancer screening6
Employee health benefits are part of an overall compensation package and affect an employee’s willingness to seek preventive services and clinical care.
Provide coverage for clinical preventive services such as mammography for breast cancer screening
- 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
- The U.S. Preventative Services Task Force recommends the following clinical screening and follow-up care:
- Clinical breast cancer screening including genetic testing for high risk women
- Diagnostic follow-up (e.g., biopsies) and treatment
- Chemopreventive medication as recommended by physician for women at high risk for breast cancer
- Prophylactic surgical removal of the breast (mastectomy), with or without reconstruction, as recommended by physician for women at very high risk for breast cancer (e.g., women with high genetic risk)
- Any 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. program must include a plan for following up women with a positive reading and referring them to clinical evaluation. It is an ethical standard widely accepted in the medical and public health community that screening programs should always be linked to a follow-up education, referral, and treatment plan
Reduce out-of-pocket costs for breast cancer screening
- Investigations have shown that reducing the cost of the intervention service for the client increases demand for and use of screening services. Employers can reduce the costs for cancer screening by paying for the screening tests or their administrative costs, by providing insurance coverage, by reducing co-payments for services, by reimbursing the client or the screening site for services rendered, or by offering any combination of these reimbursement strategies
- The Task Force on Community Preventive Services found that reducing out-of-pocket costs for screening increases 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. rates
- Bringing mobile screening services on-site is often an effective strategy to reduce out-of-pocket expenses. On-site interventions such as these reduce the cost barriers that prevent employees from receiving preventive services such as transportation to a screening facility and the need for child care
Require health plans to send reminders to both employee members and providers about breast cancer screening
- Employee and provider reminders tell people that it is time to schedule a mammogram or that they are late (recall) for a recommended screening
- Employee reminders can be mailed as a letter or postcard or communicated as part of a telephone call
- Additional information about the health benefits of the screening, strategies to overcome barriers to screening and assistance with scheduling a screening test can also be included as part of the reminder
Tools and Resources (more)
- National Business Group on Health’s A Purchaser’s Guide to Clinical Preventive Services: Moving Science into Coverage provides benefits package language for clinical breast screening
Environmental support provides a worksite physically designed to encourage good health.
Reducing structural barriers increases rates of breast cancer screening
- The Task Force on Community Preventive Services has found that reducing structural barriers to care increases rates of breast cancer screening. Structural barriers include problems such as clinic location, distance to clinic, hours of operation, appointment scheduling, language barriers, or work schedule
- Interventions to reduce structural barriers are based on the idea that making access to screening easier will increase use of screening. Examples include interventions that:
- Reduce time or distance to delivery setting
- Modify hours of service to meet client needs
- Offer services in alternative, nonclinical settings (e.g., mobile mammography vans)
- Eliminate or simplify administrative procedures (e.g., scheduling help, transportation, translation)
- Provide secondary support, such as education or ways to reduce out-of-pocket costs
Tools and Resources
- The American Cancer Society’s Workplace Solutionshas a number of cancer programs.
- The National Business Group on Health (NBGH) has developed Pathways to Managing Cancer in the Workplace which describes the economic impact of cancer to employers and discusses prevention and early detection strategies and workplace supports and services for breast, colorectal, lung, and prostate cancers.
- Why Invest? Recommendations for Improving Your Prevention Investment is a report developed by the Partnership for Prevention with support from CDC that includes examples from organizations investing in preventive services for their employees and recommendations to employers for increasing the coverage and use of preventive services