NBCCEDP: Celebrating 30 Years as Leaders in Cancer Prevention and Control
On August 10, 1990, the United States Congress enacted the Breast and Cervical Cancer Mortality Prevention Act of 1990.external icon The Act directed CDC to fund states for the purposes of screening women for breast and cervical cancer and referring them for treatment when needed; to develop information about breast and cervical cancer and share it with the public; to educate health care professionals about breast and cervical cancer detection and control; to allow states to monitor the quality of breast and cervical cancer screening; and to evaluate state programs’ activities.
With this Act, CDC established the National Breast and Cervical Cancer Early Detection Program (NBCCEDP). From the beginning, the program focused on helping women who were less likely to receive services, including those who are older, those with low incomes, and those of racial and ethnic minority groups.
In fiscal year 1991, the program received $30 million in federal funds and made its first awards. The program served more than 10,000 women during its first full program year.
The First 10 Years: The Program Grows
During its first 10 years, the program grew quickly. In 1993, Congress amended the Breast and Cervical Cancer Mortality Prevention Act to authorize funding for American Indian and Alaska Native tribal organizations. In October 1996, the program achieved truly national status with awards to all 50 states. That same year, the program reached the milestone of 1 million screening tests provided through the program.
As the decade—and the millennium—came to a close, Congress passed the Breast and Cervical Cancer Prevention and Treatment Act of 1999.external icon This Act allows states to offer those screened through the NBCCEDP access to treatment through a special Medicaid-option program. In 2001, Congress expanded this access to treatment to American Indians and Alaska Natives who are eligible for health services provided by the Indian Health Service or by a tribal organization through the Native American Breast and Cervical Cancer Treatment Technical Amendment Act.external icon
2000 Through 2010: A Focus on Quality
With all 50 states on board, the program shifted its focus from expansion to program monitoring and improvement. In her foreword to the program’s 1991–2002 National Report, NBCCEDP Director Susan True wrote, “A strategic evaluation plan will guide our assessment of program components and outcomes for the next 5 years.”
A federal advisory committee was formed to allow a wide range of experts to offer recommendations to CDC regarding the program. Its first meeting was held in 2003. That same year, CDC required award recipients to collect demographic and clinical data on everyone served. In 2004, the program established 11 priority performance measures for award recipients, and implemented a performance-based funding process the next year.
2011 to Today: Responding to a Changing Health Care Environment
NBCCEDP was designed to serve those who don’t have health insurance. The Affordable Care Act, passed in March 2010, was designed to make affordable health insurance available to more people and expand Medicaid coverage. Health care reform increased access to breast and cervical cancer screening services for many with low incomes. But many still faced substantial barriers to screening like geographic isolation, limited health literacy or self-efficacy, lack of provider recommendation, inconvenient times to access services, and language barriers.
With an extensive clinical network in place, the program placed a new emphasis on aggressive outreach to underserved communities. It educates about breast and cervical cancer screening through traditional small and social media, peer educators, and patient navigators. The program also uses population-based approaches to improve systems that increase high-quality breast and cervical cancer screening. These approaches include implementing evidence-based interventions (strategies that have been shown to increase screening) in health systems, connecting eligible populations to screening services in their communities, and informing policies that increase access to cancer screening. These efforts show that the program’s capabilities go beyond its original purpose of detecting breast and cervical cancers in those less likely to be screened.
In the 2021–2022 program year, the NBCCEDP funds 70 award recipients: all 50 states, the District of Columbia, 6 U.S. territories, and 13 tribal organizations. Since 1991, NBCCEDP-funded programs have provided more than 15 million breast and cervical cancer screening tests to nearly 6 million patients, leading to the diagnosis of more than 73,000 breast cancers and almost 5,000 cervical cancers.