Breast

1
Breast Cervical Cancer Section
Overview
Collaborative Leadership Retreat April 17-18, 2007

• John Boyle, MBA
• Section Chief, Breast Cervical Cancer Section
• Division of Cancer Prevention Control
• Bureau of Health Promotion Risk Reduction

2
Comprehensive Cancer Plan

• The Department of Health believes that
  collaboration is the key to reducing the burden
  of cancer.

3
Comprehensive Cancer Plan (cont.)

• Goals Related to Breast Cervical Cancer
• Cancer Screening and Diagnostic Follow Up
• GOAL B All Pennsylvanians will have the
  opportunity to take advantage of cancer screening
  services.
• Cancer Prevention and Healthy Lifestyles
• GOAL H All women in Pennsylvania at higher risk
  for cervical cancer will have the knowledge and
  the resources to have Pap smears according to
  evidence-based guidelines and to receive
  appropriate follow-up of abnormal screening
  results.
• Access
• GOAL A Every Pennsylvanian will have access to
  primary care, cancer prevention/screening, and
  cancer care by eliminating barriers.

4
Cancer Burden in Pennsylvania

• Breast cancer remains the second major cause of
  cancer-related mortality in women nationwide and
  in PA
• Cervical cancer mortality rates have remained
  stable and low
• Average annual age-adjusted incidence rate
  (2000-04) for breast cancer among white females
  was slightly higher than the rate for
  African-Americans.
• Women who are African-American, Hispanic and/or
  Asian/Pacific Islander were more likely to be
  diagnosed at a later stage disease as compared to
  whites for both types of cancer.
• In 2005, the overall mortality rate for breast
  cancer decreased to 24.8 per 100,000, a 23
  decline from 1996 however, the death rates in
  African-Americans declined by only 10.

5
Cancer Burden (cont.)

• Common barriers to early detection screening
  services are
• Lack of perceived risk
• Lack of access to screening services
• Lack of physician referral, and
• A culturally insensitive system including
  language barriers, inability to pay for screening
  or treatment should cancer be diagnosed.

6
Current Programs Activities

• HealthyWoman Program
• Act 74 of 2005 Effective July 1, 2006
• Breast and Cervical Cancer Prevention Treatment
  Program in place since 2002
• 67 Women/67 Counties Facing Breast Cancer in
  Pennsylvania
• Breast and Cervical Cancer Research Initiative
• Cervical Cancer Task Force

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NBCCEDP Project Relationship
8
HealthyWoman Program

• PAs National Breast and Cervical Cancer Early
  Detection Program Project
• Funding provides
• Breast and Cervical Cancer Screening
• Diagnostic Testing for Abnormal Screening
  Results
• Referral to BCCPT Program

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Components of the NBCCEDP
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HWP Eligibility Guidelines

• Ages 40-64 years old
• Low to Moderate Income
• Uninsured or Underinsured
• Number of women served through the HWP is
  dependent upon
• Annual funding available from the CDC
• Our ability to reach CDC benchmarks

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HWP Eligibility Guidelines (cont.)
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Act 74 of 2005 (aka House Bill 1606)

• Enacted on July 1, 2006
• Expansion of the HWP
• In SFY 2006-07 4,200 additional women to be
  screened
• New initiative coincides with the American Cancer
  Societys recommendation that annual mammograms
  begin at age 40

13
HWP Statistics

• Services Performed Since 1994
• 54,213 Unduplicated Clients Screened
• 49,173 Initial Visits (first time clients)
• 68,808 Mammograms
• 54,347 Pap Tests
• 1,662 Breast Cancers Detected
• 96 Cervical Cancers Detected
• Breast Cancer figure includes Ducal and
  Lobular In Situ cases.Some BC cancers were
  already detected outside the HWP, but were
  confirmed at consult visits prior to BCCPT
  enrollment

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Breast and Cervical Cancer Prevention and
Treatment Program (BCCPT)

• Administered by the Pennsylvania Department of
  Public Welfare (DPW)
• Provides treatment for HWP women diagnosed with
  breast or cervical cancer or pre-cancerous
  conditions through the Medicaid program
• Coordinated effort between the HWP Providers and
  the DPW local County Assistance Offices (CAOs)

15
BCCPT Program Eligibility

• Women must receive at least one federally funded
  screening service through HWP
• Local CAO determines eligibility for Medicaid or
  BCCPT (only) services
• If woman is eligible for general Medicaid, she
  will receive medical coverage, plus all other
  eligible benefits

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BCCPT Program Eligibility (cont.)

• If the woman is not eligible for general
  Medicaid, she is placed in the BCCPT Program and
  receives medical coverage until completion of
  cancer treatment
• The BCCPT Program then suggests the woman contact
  the HWP to continue annual screenings
• Since 2002, the BCCPT Program has served 2,719
  women referred from the HWP

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BCCPT Program Eligibility (cont.)

• A Treatment Plan is selected based on the
  specific cancer diagnosis for each client
• Precancerous condition 3 months
• Localized cancer 6 months
• Metastatic cancer 12 months
• Requests for renewals for further treatment
  needed beyond the selected treatment plan above
  are then submitted by health providers

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Pennsylvania Breast Cancer Coalition

• 67 Women/67 Counties Facing Breast Cancer in
  Pennsylvania
• Since 1994, the educational exhibit has been
  hosted by over 80 communities and reached
  millions of Pennsylvanians through the extensive
  media coverage it attracts.

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Breast Cervical Cancer Research Initiative

• Individual citizens donate all or part of their
  PA income tax refunds to fund these grants
• Number of grants awarded depends on the
  contributions made to the Breast and Cervical
  Cancer Research Fund
• The current maximum per grant contribution is
  35,000.
• DOH solicits research applications on breast and
  cervical cancer from Pennsylvania institutions
  and organizations

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BCC Research Initiative (cont.)

• Grant term is one year and application submission
  is limited to specific research entities
• Overall goal is to promote research directed
  toward reducing the incidence and mortality
  associated with breast and cervical cancer
• From tax year 1997 through 2006, 1,023,385.89
  has been provided in grant contributions to 50
  research grants.

21
Cervical Cancer Task Force (CCTF)

• Act 74 of 2006 authorized the Department of
  Health to establish a Cervical Cancer Task Force
• The Task Force is to evaluate and make
  recommendations for education and prevention of
  cervical cancer
• On or before November 30, 2007, the CCTF will
  present its report to the Senate Chairman of the
  Public Health and Welfare Committee and House of
  Representatives Chairman of the Health and Human
  Services Committee

22
Organizational and Partnership Structure

• CDC (Source of federal funding)
• Cancer Advisory Board
• American Cancer Society
• PA Breast Cancer Coalition
• Linda Creed Foundation
• Susan G. Komen for the Cure
• National Cancer Institute
• PAC³

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Relevant Roles and Responsibilities

• Leslie Best, DirectorBureau of Health Promotion
  Risk Reduction
• Susan George, DirectorDivision of Cancer
  Prevention Control
• John Boyle, Section Chief Breast and Cervical
  Cancer Section
• Oversees the PA Breast and Cervical Cancer
  efforts in the Department.

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Relevant Roles and Responsibilities (cont.)

• Roslyn Rhodes, HWP Manager
• Directs the day-to-day operations of the
  HealthyWoman Program service grant
• Barbara Caboot, Public Education and Outreach
  Administrator
• Administers all of the Public Education and
  Outreach activities for the HWP and BCC Section

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Relevant Roles and Responsibilities (cont.)

• Zeenat Rahman, Epidemiologist
• Provides Epidemiological support, surveillance
  and evaluation to the HWP.
• Diane Ollivier, Program Analyst
• Work closely with Program staff, Epidemiologist,
  CDC, and other agencies to analyze data related
  to the HWP.

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Relevant Roles and Responsibilities (cont.)

• Nursing Services Consultant
• Acts as the quality improvement coordinator for
  the Breast and Cervical Cancer Section and the
  HWP.
• Kristi Klinger, Administrative Officer
• Amanda Moyer, Administrative Assistant
• Serve as the fiscal managers of the BCC Section
  and the HWP

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Bureau Organization Chart
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Questions or Comments?
Contact Info John N. Boyle Pennsylvania Departmen
t of Health Room 1011 Health Welfare Building
Harrisburg PA  17120 Phone (717)
346-3980Fax     [phone] E-mail
jboyle_at_state.pa.us