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MARCH / APRIL 2014 :: 75(2)
Medical Imaging

Medical imaging has revolutionized screening and diagnosis, but this technology is not risk-free. As use of advanced imaging has grown, attention has increasingly focused on the risks of radiation exposure, the anxiety associated with incidental findings, and the costs of such imaging. This issue of the NCMJ will address the pros and cons of medical imaging and will discuss how this technology can be used more safely and effectively.

SPOTLIGHT ON THE SAFETY NET

The North Carolina Breast and Cervical Cancer Control Program

Vicki W. Deem, Debi Nelson, Terence Fitz-Simons, Kathie Johnson, Evelyn Herring

N C Med J. 2014;75(2):149-150.PDF | TABLE OF CONTENTS



The North Carolina Breast and Cervical Cancer Control Program (BCCCP), which began in 1992, is part of the National Breast and Cervical Cancer Early Detection Program. Funding for the BCCCP is currently provided through a competitive 5-year grant from the Centers for Disease Control and Prevention, and the North Carolina General Assembly allocated additional annual funds for screening in 2007. Using both funding sources, the BCCCP served 56,867 women between July 2007 and June 2012.

The BCCCP helps uninsured and underinsured women gain access to breast and cervical cancer screening and some diagnostic services. Women with incomes up to 250% of the federal poverty guidelines are eligible for services, which include clinical breast examinations, mammograms, Papanicolaou (Pap) tests, human papilloma virus testing, limited diagnostic testing for abnormal screening results, and case management and navigation for clients with abnormal findings. In terms of age limitations, cervical cancer screening is available for women aged 21–64 years, and breast cancer screening is available for women aged 40–64 years [1]. The BCCCP also serves as the portal of entry to the North Carolina Breast and Cervical Cancer Medicaid program, which provides treatment services for eligible women.

As Figure 1 shows, incidence and mortality rates for female breast cancer in 2010 were higher in North Carolina than in the United States as a whole [2]. Regular mammograms may help to reduce breast cancer mortality by facilitating earlier detection of tumors; indeed, a mammogram can detect a tumor as much as 3 years before it can be felt [3]. Women aged 50–75 years should have mammograms every 1–2 years, and women in other age groups should talk to their health care providers about when to have a mammogram [3]. The BCCCP works to raise awareness of this valuable screening test and encourages women to be screened. BCCCP providers can also perform a skilled, evidence-based clinical breast examination, which is another element of good breast health.

BCCCP services are available at local agencies throughout North Carolina, including most local health departments, and in 4 hospital systems, 1 tribal organization, and 6 community health centers. (To find a local provider by county, visit http://bcccp.ncdhhs.gov/.) Each local agency works with providers and other organizations in the community to reach and serve at-risk women. The Sampson County Health Department BCCCP and the Lenoir County Health Department BCCCP are 2 examples of strong local collaborations that are reaching out to eligible women in rural communities.

The Sampson County Health Department and the Sampson County BCCCP Advisory Board are strongly committed to working with other agencies to provide breast and cervical cancer screening services to eligible women. In addition to providing BCCCP-funded clinical services, health department staff members and advisory board members donate their time for outreach to community groups and churches. The goal is to reach high-risk African-American women and other minority populations and to provide these individuals with information about available services. The advisory board and the health department recently held their 15th Annual Breast Cancer Awareness Rally, which included more than 200 participants. Local partners of the Sampson County Health Department and their BCCCP advisory board include United Way, South River Electric Membership Corporation, Sampson Regional Medical Center, Goshen Medical Center in Clinton, and Clinton Surgical Associates. These partners are working together to augment BCCCP services by providing outreach, free mammograms and Pap tests, follow-up diagnostic testing, and referrals for eligible women.

Lenoir County Health Department’s BCCCP is another good example of a local collaboration that is working to reach out to eligible women. An informed public is the key to the program’s success, and the Lenoir County Health Department uses several methods to inform eligible women about the BCCCP. These outreach efforts include events such as health fairs, mailings to medical providers, bulletin boards, newspaper articles, pamphlets or booklets in waiting rooms, radio announcements, word of mouth, and special activities during Breast Cancer Awareness Month (October) and Cervical Health Awareness Month (January). In other collaborative work, the Lenoir County Health Department has identified a medical provider in an adjacent county who accepts patients at the current BCCCP payment rate and another provider who offers interpretive services for women who do not speak English.

In October 2013 Lenoir County Health Department hosted the countywide kickoff for Breast Cancer Awareness Month. Local officials and state BCCCP staff members attended this event, and physicians spoke to attendees about the latest techniques for diagnosis. Breast cancer survivors also spoke about their personal experiences with the disease, and vendors provided information about their services. The local newspaper covered the event in an article that included interviews with survivors and positive comments about the program and its management.

The statewide success of the BCCCP is due not only to the federal and state resources provided to the program but also to the infrastructure afforded by local health departments and providers who are committed to the program.

Acknowledgments
The North Carolina Breast and Cervical Cancer Control Program is supported by a grant from the Centers for Disease Control and Prevention and by state appropriations.

Potential conflicts of interest. All authors have no relevant conflicts of interest.

References
1. Centers for Disease Control and Prevention (CDC). National Breast and Cervical Cancer Early Detection Program (NBCCEDP). About the program. CDC Web site. http://www.cdc.gov/cancer/nbccedp/about.htm. Page last updated September 10, 2013. Accessed December 3, 2013.

2. Centers for Disease Control and Prevention (CDC). State cancer facts. North Carolina Cancer Data. Incidence rates and death rates for 2010. Downloadable from CDC Web site. http://apps.nccd.cdc.gov/statecancerfacts/state.aspx?state=North Carolina. Accessed December 3, 2013.

3. Centers for Disease Control and Prevention (CDC). National Breast and Cervical Cancer Early Detection Program (NBCCEDP). Breast Cancer Facts. CDC Web site. http://www.cdc.gov/cancer/nbccedp/pdf/toolkit/NBCCEDP_2011_BCFacts_Gen_508.pdf. March 2011. Accessed December 3, 2013.


Vicki W. Deem, MLS, MPA, RN public health nurse consultant II, Cancer Prevention and Control Branch, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, North Carolina.
Debi Nelson, MAEd branch head, Cancer Prevention and Control Branch, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, North Carolina.
Terence Fitz-Simons, PhD data manager and epidemiologist, Cancer Prevention and Control Branch, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, North Carolina.
Kathie Johnson, RN, ADN director of nursing, Sampson County Health Department, Clinton, North Carolina.
Evelyn Herring, RN Breast and Cervical Cancer Control Program coordinator, Lenoir County Health Department, Kinston, North Carolina.

Address correspondence to Ms. Vicki W. Deem, North Carolina Division of Public Health, Cancer Prevention and Control Branch, 5505 Six Forks Rd, 1st Fl, Raleigh, NC 27609 (vicki.deem@dhhs.nc.gov).