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Cervical 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 cervical 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 cervical cancer screening programs.
Cervical cancer is the easiest female cancer to prevent, because there is a vaccine and a screening test available. It also is highly curable when found and treated early.
- In 2007, 12,280 women in the United States were diagnosed with cervical cancer, and 4,021 died from the disease1
- The direct medical care costs associated with cervical cancer were estimated to equal $1.7 billion in 1996 dollars2
- The 5-year survival rate for patients diagnosed with localized cervical cancer is 92%
- Cervical cancer is diagnosed at an early stage more often in whites (53%) than in African Americans (44%) and in women younger than 50 (62%) than in women 50 and older (37%)
- The most common cause of cervical cancer is the human papillomavirus (HPV). Tobacco use and obesity also increase the risk of cervical cancer
The United States Preventive Services Task Force recommends:
- Cervical 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. (cervical Papanicolaou or PAP test) for all women who have been sexually active and have a cervix, beginning within 3 years of the onset of sexual activity or the age of 21, whichever occurs first, repeated at least every 3 years, and continuing until the age of 65 for adult women of normal risk or unless the woman receives a hysterectomy for benign disease
The Pap test is conducted by scraping cells from the cervix of the uterus and sending them to a laboratory for cytologic assessment. Newer screening methods for cervical cancer include thin-layer preparations, computer-assisted screening and testing for human papillomavirus (HPV). At present, the U.S. Preventive Services Task Force finds insufficient evidence to compare these with the Pap test. However, all these methods are FDA-approved and appropriate to consider for a health benefits package.
In Rankings of Preventive 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, cervical 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. received a ranking of 7 on a scale of 1-10, with 10 the highest ranking.
One study estimated that the cost-effectiveness ratio of a conventional Pap test repeated every three years up to the age of 75 was $11,830 per quality adjusted life year (QALY) saved (in year 2000 dollars).3 In comparison with other preventive interventions and with cost-effectiveness benchmarks, cervical cancer screening is highly cost-effective.4 The harms of screening for cervical cancer are small compared to the benefits. False-positive screening results may lead to unnecessary treatment of low-grade lesions, unnecessary evaluations and biopsies, and psychological stress.
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 cervical 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 cervical cancer 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 healthcare 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.
Tools and Resources (more)
- The Centers for Disease Control and Prevention's (CDC) Inside Knowledge Campaign includes a number of education materials such as fact sheets, campaign messages, and links to support and provider organizations to raise awareness of the five main types of gynecologic cancer: cervical, ovarian, uterine, vaginal, and vulvar
- Additional CDC resources for cervical cancer are available including basic information, statistics, podcasts, and links to other organizations
- 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..”
Health benefits to support cervical cancer screening5
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 cervical cancer screening
- Cervical cancer screening is a valuable early detection tool that can identify cancer at an early stage, when treatment is more effective and less expensive
- In addition to cervical cancer screening, coverage for younger women should include immunization with the human papillomavirus vaccine (HPV) in accordance with recommendations by the Advisory Committee on Immunization Practices (ACIP). The recommended ages to receive the vaccine are 11-12 years (3-dose series with the second and third doses administered 2 and 6 months after the first dose). However, catch-up vaccination is recommended for females up to 26 years who have not been previously vaccinated. Vaccination is not a substitute for routine cervical cancer screening, and vaccinated females should have cervical cancer screening as recommended
- Benefit packages should include personal reminders to employees regarding their due dates for screening
- 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
Require health plans to send reminders to both employee members and providers about cervical cancer screening
- Employee and provider reminders tell people that it is time to schedule a Pap test 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 cervical cancer screening
Environmental support provides a worksite physically designed to encourage good health.
Tools and Resources
- In addition to the following suggestions for health-related programs and policies, health benefits, and environmental support for cervical cancer screening programs, see recommendations for obesity, physical activity, and tobacco use that relate to cervical cancer risk
- The American Cancer Society’s Workplace Solutions (http://www.acsworkplacesolutions.com/) has a number of cancer programs
- 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