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                                 CERVICAL CANCER SCREENING                                                                        HERE
                                 SECTION OF SC CANCER PLAN
                                                                                                                         (Note: Please initial below each
                                                                                                                        comment or suggestion that you
                                 BACKGROUND INFORMATION                                                                   make to assist us in compiling
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     Objective/Strategy           Year     Indicator     Indicator Notes         Baseline     Current Documented      Please Provide       Please Provide
                                 Created    Rating                                              Status on Work          Information        Suggestions for
                                              (See                                                  Towards              about any       How this Objective
                                            legend                                              Accomplishing            Additional      or Strategy Should
                                           at end of                                          Objective or Strategy       Progress        be Updated (such
                                               this                                                                       Towards           as “no further
                                             table)                                                                   Accomplishing        action needed;”
                                                                                                                      this Objective      “modify measure
                                                                                                                       or Strategy:       to read…”, “next
                                                                                                                                            steps…” etc.):
Objective 4: By June 2010,       2005      A1          It appears this         2002=88.3%;    86.1% in 2008           Identifying        There are
increase the proportion of                             indicator was           2004=87.1%;                            rarely and         concerns that the
women at risk for cervical                             calculated from % of    2006=86.8%;                            never screened     proportion of
cancer (including never/rarely                         adult women             2008=86.1%                             women              women screened
screened, uninsured, age-                              screened for cervical                                          continues to be    is slightly
specific populations) who                              cancer in past 3        Baseline                               a challenge.       decreasing and
have received screening                                years (or was it        =2002                                  Will resources     moving farther
services within the preceding                          calculated from a                                              be devoted to      away from the
three years from 86.8% to at                           population subset as                                           such actions       desired target of
least 90% (SC BRFSS, 2002).                            described in                                                   needed to          90%.
                                                       indicator?);                                                   identify
                                                                                                                      rarely/never       What are the
                                                                                                                      screened           updated Health
                                                                                                                      women?             People goals for
                                                                                                                                         cervical cancer?
                                                                                                                                         (see last page for
                                                                                                                                         summary of
                                                                                                                                         proposed 2020
Strategy1: Collaborate with      2005      B3          Rec: Is this really     2005; Not                              This is            Identify
providers to develop office-                           feasible for SCCA?      accomplished                           reflected in the   collaborative
tracking systems to support                            How would you do        yet                                    proposed 2020      providers – start
timely re-screening.                                   this? Funding?;                                                objectives in      with FQHCs
                                                       Could be more                                                  terms of           and/or 5-10
                                                       precise by saying to                                           primary health     counties with the
                                            have recall systems                                                care providers.    most rural
                                            installed in x% of                                                 In order to        populations or
                                            PCP offices.                                                       assess this        provider
                                                                                                               strategy, a        shortages – do a
                                                                                                               statewide          pilot. This would
                                                                                                               survey of some     give support for
                                                                                                               sort would         what types of
                                                                                                               likely be in       tracking systems
                                                                                                               order to collect   are needed and
                                                                                                               information        what could be
                                                                                                               from a sample      effective. Many
                                                                                                               of providers of    rural practices do
                                                                                                               all types.         not have EMRs,
                                                                                                                                  but other systems
                                                                                                                                  could be devised
                                                                                                                                  that could prove
                                                                                                                                  effective. There is
                                                                                                                                  a move toward
                                                                                                                                  EMR and some
                                                                                                                                  funding is linked
                                                                                                                                  to EMR
                                                                                                                                  implementation by
                                                                                                                                  certain dates for
                                                                                                                                  certain providers.

Strategy 2: Support             2005   C2   How do you measure       2005; Not      • Moving to Action         A lot of work      Change wording
dissemination of new                        supporting               accomplished   Addressing Cervical        has been done      into numbers that
information to provide the                  dissemination; better    yet            Cancer in SC June          here! It seems     better enable
public, as well as clinicians               to say to disseminate                   2008 and upcoming          we need to put     measurement – we
and public health                           x info to x                             follow-up efforts of the   some               could focus on the
professionals, with current                 individuals. "Public",                  Public Health              numerical          state’s FQHCs
and evolving science,                       "clinicians" and                        Campaign and Health        measures into      and/or the primary
technology, and guidelines                  "public health                          Care Provider              the wording of     care practices
specific to cervical cancer                 professionals" are 3                    Education.                 the strategy       which exist in the
screening.                                  distinct audiences.                     • Latina Initiative-       that would         most rural 5-10
                                                                                    Spanish language           ensure             counties in SC.
                                                                                    outreach and health        achievement        Would need
                                                                                    communication to           toward meeting     financial support
                                                                                    reach the rarely and       this strategy.     to pull this
                                                                                    never screened. The                           together.
                                                                                    Latina Initiative is       Updating the
                                                                                    funded in part by the      flyer partially
                                                                                    SCCA. The portion          sponsored by
                                                                                    funded by the SCCA is      the SCCA to
                                                                                    the evaluation of the      include
                                                                                    Spanish language           updated
                                                                                  CEG. This work             vaccination
                                                                                  continues. We are          information,
                                                                                  launching the first        such as
                                                                                  coordinated, Spanish       approval for
                                                                                  language health            males.
                                                                                  campaign in October.
                                                                                  We will have
                                                                                  newsletters, radio
                                                                                  PSAs, print ads, and
                                                                                  stories. The October
                                                                                  campaign focuses on
                                                                                  breast cancer. January
                                                                                  will focus on cervical
                                                                                  cancer. April will focus
                                                                                  on access to health
                                                                                  • Cancer Education
                                                                                  Guide Trainings
                                                                                  • The SCCA co-
                                                                                  sponsored a flyer
                                                                                  about adolescent
                                                                                  vaccination (includes
                                                                                  info on HPV
                                                                                  vaccine/Gardasil) that
                                                                                  will be mailed out to
                                                                                  parents in our state.
Strategy 3: Collaborate with    2005   C2   Rec: "dissemination    2005; Not      • A Call to Action:        Do the            List / document the
faith-based organizations and               of information" vs.    accomplished   Preventing Cervical        documented        faith-based and
community organizations to                  "education" or         yet            Cancer among               strategies        community
disseminate cervical cancer                 "educate."; More                      African-American           include the       organizations that
information.                                precise to say to                     women in March 2007        Witness           have participated in
                                            collaborate with x                    was funded in part by      Project, an       this effort. Much of
                                            organizations to get                  the SC Cancer              evidence-based    this work is
                                            message                               Alliance. This effort      breast and        documented in the
                                            disseminated to x                     was open to all but        cervical cancer   JSCMA Oct 09
                                            people.                               focused on the             educational       issue.
                                                                                  African-American faith     program in
                                                                                  community. A poster        faith-based
                                                                                  and several                settings?
                                                                                  documenting these          Much of this
                                                                                  efforts and won an         strategy has
                                                                                  award at the NCI           been
                                                                                  Cancer Disparities         accomplished.
                                                                                  Summit Summer 2008.        How can these
                                                                                 Efforts from this         efforts be
                                                                                 meeting have been         expanded
                                                                                 continued by….            statewide and
                                                                                 • Continued offering of   sustained?
                                                                                 cervical cancer
                                                                                 education and
                                                                                 outreach in partnership
                                                                                 with the SBYWA.
Strategy 4: Collaborate with      2005   C3   How do you expand   2005; Not      This has been             The challenge     Identify providers
community partners and                        services without    accomplished   addressed at a            to address        that have the
medical providers to expand                   monetary            yet            statewide level with      gaps in           ability to provide
current screening and                         commitment? Who                    the expansion of the      financing and     follow-up care for
diagnostic resources, with an                 are the medical                    BCN as this program       funding of        low-income /
emphasis on high-risk                         providers and the                  now offers a full range   follow-up care    uninsured women
women.                                        community                          of services to the 40-    of abnormal       who are screened,
                                              partners?; How to                  46 age group.             screening         but have abnormal
                                              measure if you                                               results           results. Specify
                                              collaborated to                                              persists.         exactly who
                                              expand services?;                                                              comprises the
                                                                                                                             other groups of
                                                                                                                             high-risk women.
                                                                                                                             Not sure what the
                                                                                                                             role of community
                                                                                                                             partners would be
                                                                                                                             in this strategy –
                                                                                                                             perhaps to identify
Strategy 5: Collaborate with      2005   A2   This is nice        2005; Not      • These issues were       Collaboration     There are
the Research Task Force to                                        accomplished   addressed in journal      between/among     remaining
identify areas/sub-populations                                    yet            article written by        constituencies    opportunities to
who are at highest risk for not                                                  researchers including     within the        better understand
being screened for cervical                                                      Dr Heather Brandt,        SCCA and          rarely and never
cancer.                                                                          Chair of the Cervical     individuals       screened
                                                                                 Cancer Subcommittee       external who      women… how to
                                                                                 of the Breast and         are not yet       identify them and
                                                                                 Female Cancer WG          members are       how to best meet
                                                                                 and Dr James Herbert,     needed to         their needs to
                                                                                 Research Task Force       explore social    reduce cancer
                                                                                 Chair. There are still    determinants      mortality.
                                                                                 opportunities in this     (such as
                                                                                 area.                     discrimination,   A number of other
                                                                                 Brandt HM, Modayil        distrust,         research
                                                                                 MV, Hurley D, Pirisi-     educational       opportunities
                                                                                 Creek LA, Johnson         experience,       exist. Better
                                                                                 MG, Davis J, Mathur       etc.) common      understanding of
                                                                                 SP, Hebert JR.            to lower          provider
                                                                                             Cervical cancer            proportions of     adherence to
                                                                                             disparities in South       participation in   current cervical
                                                                                             Carolina: An update of     cancer             cancer screening
                                                                                             early detection, special   prevention and     recommendations;
                                                                                             programs, descriptive      control across     increasing
                                                                                             epidemiology, and          different types    initiation and
                                                                                             emerging directions. J     of cancer (and     uptake of HPV
                                                                                             South Carolina Med         other chronic      vaccination using
                                                                                             Assoc 2006;102:223-        diseases) as       informed decision
                                                                                             30.                        well as            models and other
                                                                                                                        diseases with a    promising
                                                                                                                        strong             strategies; and
                                                                                                                        connection to      innovative
                                                                                                                        cancer (such as    approaches to
                                                                                                                        HIV and            further increasing
                                                                                                                        cervical           adherence to
                                                                                                                        cancer).           screening and
                                                                                                                                           follow-up care are
                                                                                                                        Dr. Lisa           just a few
                                                                                                                        Wigfall’s grant    examples.
                                                                                                                        application, if
                                                                                                                        progress in this
                                                                                                                        strategy. Might
                                                                                                                        need to be
                                                                                                                        more specific
                                                                                                                        about how this
                                                                                                                        will be done.

Legend: The indicator rating score is a summary of two measures that describe how feasible it will be to measure an objective or strategy.

The letter part of the score describes the quality of evaluation objectives or strategies:
        A=Measurable as written
        B=Measurable with minor changes to the wording
        C=Measurable with major changes to the wording

The numeric part of the scale that could be used to describe the ease of measurement for objectives or strategies:
       1=Data currently available
       2=Data available with secondary data collection (ie. data could be compiled from existing data sources)
       3=Data available with primary data collection (ie. original data collection would be required)
      A higher letter/number score would indicate a better objective or strategy. For example: An A1 rating would indicate that an objective or
      strategy is “measurable as written and data is available to measure it.” A B1 rating would indicate that an objective or strategy is “measurable
      with minor changes and data is available with primary data collection.”

                               Are there any Additional Goals, Objectives or Strategies that You Would
                                     Recommend we ADD to any section of the SC Cancer Plan?

                                                           Please Add Them Below:
It is important to examine the proposed Healthy People 2020 objectives for cervical cancer prevention and control. South Carolina is in a position
to include similar objectives and state-relevant strategies to achieve these objectives on a state level.

                                                    Proposed Healthy People 2020 Objectives

                                        All listed are specific to cervical cancer prevention and control


Objectives Retained As Is From Healthy People 2010
C HP2020-4: Reduce the death rate from cancer of the uterine cervix
C HP2020-9: Increase provider counseling about cancer prevention
     b. Primary care providers – Pap tests

Objectives Retained But Modified From Healthy People 2010
C HP2020-14: Increase the proportion of women aged 18 years and older who receive a cervical cancer screening based on the most
recent guidelines

Objectives New to Healthy People 2020
C HP2020-19: Decrease incidence of invasive uterine cervical cancer

Proposed Objectives on Cancer (public comment period)
   Increase Human Papillomavirus (HPV) vaccination among adolescents 11-18 years.
   Increase education to the U.S. public about cancer risks and prevention.
   Reduce cancer disparities experienced by the medically underserved

Objectives Retained But Modified From Healthy People 2010
IID HP2020-22: Increase routine vaccination coverage levels for adolescents

Objectives New to Healthy People 2020
IID HP2020-29: Increase the number of states that have 80% of adolescents with two or more age-appropriate immunizations
recorded in immunization information systems (adolescents aged 11-18 years)
IID HP2020-30: Increase routine vaccination coverage levels for adolescents with vaccines recommended by the Advisory Committee
on Immunization Practices


Objectives Retained But Modified From Health People 2010
STD HP2020-7: (Developmental) Reduce the proportion of females with human papillomavirus (HPV) infection
[NOTE: I disagree with the gender-specific nature of this objective. The objective should include females and males.]

   Access to Health Services
   Adolescent Health (as related to HPV vaccination)
   Educational and Community-Based Programs
   Health Communication and Health IT
   Social Determinants of Health

Add objective explicitly focused on follow-up care in terms of accessibility and affordability (including financing). As noted in our comments, it is
also important to ensure timely follow-up care, i.e. within 90 days, whenever possible and feasible. This further required providers to adhere to the
most recent recommendations of major medical and public health organizations.

Consider a survey of providers to identify adherence to current screening guidelines and appropriate use of HPV testing. This could be in the form of
a pilot. I think Dr. Judy Burgess (USC) has already done some work in this area among University MDs? Not sure if this has been published or exactly
which population she studied.

Again – a focus could be on the FQHCs – they have the data. The other area on which to focus is rural counties in SC – what / how do these providers
adhere to cervical ca screening guidelines? Pilot survey would be useful in guiding us.
It is also important to be mindful of the growing Latino/a population in South Carolina, and the importance of language- and culturally-appropriate
cervical cancer prevention and control programs and services. The same can be true of other populations with unique needs, such as sexual
minority women.
Comments from Andrea Williams (Institute for Partnerships to Eliminate Health Disparities, USC), Sharon Bond
(MUSC), and Heather Brandt (USC)