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Federal screening program reduced cervical cancer-related mortality in low-income women
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The National Breast and Cervical Cancer Early Detection Program decreased cervical cancer-related deaths among low-income, medically underrepresented women who utilized the program’s services, according to recent findings.
“To reduce disparities in cervical cancer incidence and mortality, in 1990, the US Congress passed the Breast and Cervical Cancer Mortality Prevention Act,” study researcher Donatus Ekwueme, PhD, of the CDC’s Division of Cancer Prevention and Control, and colleagues wrote. “The law authorized the establishment of the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) to reach underserved women. The program is administered by the CDC in all 50 states, District of Columbia, tribal organizations and US territories to provide low-income, uninsured women aged 18 to 64 years with cancer screening, diagnosis and referral to treatment.”
To estimate the benefits in life-years gained, quality-adjusted life-years gained and deaths averted, Ekwueme and colleagues used a time-dependent Markov state transition model to calculate the benefits of the NBCCEDP.
The model made the following assumptions: that all cervical cancers develop from HPV and that cervical cancer may progress to squamous intraepithelial lesions and to invasive cancer.
Researchers adjusted the model’s parameters further to match HPV, low-grade squamous intraepithelial lesions, high-grade squamous epithelial lesions and the prevalence of cervical cancer recorded in accessible data.
The researchers used the model to estimate outcomes for NBCCEDP patients, aged 18 to 64 years, who were diagnosed with HPV, low-grade lesions, high-grade lesions and cervical cancer after program-administered screenings. Data from the National Health Interview Survey from 1990 to 2005, as well as NBCCEDP data from 1991 to 2007, were used to approximate the screening patterns of uninsured, low-income women.
The researchers created separate simulations for three situations: women who underwent NBCCEDP screening; women who underwent screening without the program; and women who did not receive any screening.
According to study results, among 1.8 million women screened, those screened through the NBCCEDP accumulated 10,369 life-years vs. those screened without the program, and 101,509 life-years vs. no screening.
The researchers found that an estimated 325 cervical cancer-related deaths were averted through NBCCEDP screening compared with non-NBCCEDP screening, and 3,829 deaths were prevented through NBCCEDP screening vs. no screening.
In addition, during the study, the researchers found that 15,589 quality-adjusted life-years gained were attributable to use of NBCCEDP screening vs. non-program screening, and 121,529 quality-adjusted life-years gained were attributable to program-related screening vs. no screening.
“The estimates suggest that the NBCCEDP has succeeded in reducing cervical cancer morbidity and mortality among medically underserved, low-income women who received preventive health services through the program,” Ekwueme and colleagues wrote. “Although, the program only reaches about 10% of eligible population, this success has been a result of strong collaboration and sustained commitment from program administrators at CDC, coordinators at state health departments, health policymakers, and from the program’s public and private partners for the past 20 years.”
Disclosure: One of the researchers served as a member of the Advisory Panel for the NBCCEDP.
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