Strengthening breast and cervical cancer control through partnerships: American Indian and Alaska Native Women and the National Breast and Cervical Cancer Early Detection Program

Abstract

The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) has played a critical role in providing cancer screening services to American Indian and Alaska Native (AI/ANs) women and strengthening tribal screening capacity. Since 1991, the NBCCEDP has funded states, tribal nations, and tribal organizations to develop and implement organized screening programs. The ultimate goal is to deliver breast and cervical cancer screening to women who do not have health insurance and cannot afford to pay for these services. The delivery of clinical services is supported through complementary program efforts such as professional development, public education and outreach, and patient navigation. This article seeks to describe the growth of NBCCEDP's tribal commitment and the unique history and aspects of serving the AI/AN population. The article describes: 1) how this program has demonstrated success in improving screening of AI/AN women; 2) innovative partnerships with the Indian Health Service, state programs, and other organizations that have improved tribal public health infrastructure; and 3) the evolution of Centers for Disease Control and Prevention work with tribal communities. Cancer 2014;120(16 suppl):2557-65. V C 2014 American Cancer Society.KEYWORDS: American Indians, Alaska Natives, early detection of cancer, breast cancer, cervical cancer, partnerships. INTRODUCTIONProviding health services to American Indians and Alaska Natives (AI/ANs) poses unique challenges related to geographic isolation, cultural attitudes, poverty, and language. Nonetheless, the Indian Health Service (IHS), working with its tribal, state, and federal partners, offers unique opportunities to deliver health care for members of federally recognized tribes. IHS-initiated cervical cancer screening in the 1960s and 1970s contributed to declining incidence of cervical cancer and mortality rates in the 1980s and 1990s. However, screening mammography provided to women served by the IHS before the establishment of the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) of the Centers for Disease Control and Prevention (CDC) was very limited. 1,2 We describe the important contributions of NBCCEDP, in partnership with the IHS tribal programs and state programs. We review how these efforts improved access of breast and cervical cancer screening to AI/AN women and strengthened the tribal screening infrastructure. We begin with a brief history of the role of IHS and NBCCEDP in addressing the burden of breast and cervical cancer and include the impact of the program using multiple data sources. We discuss considerations important in working with tribal communities and provide examples of partnerships created between state and tribal grantees and between federal agencies.

Cancer Screening Test Use — United States, 2015

“…Lower mammography use might lead to breast cancer diagnosis at later stages and contribute to racial disparities in mortality. The National Breast and Cervical Cancer Early Detection Program supports 11 AI/AN tribes and tribal organizations to increase screening use in these communities ( 4 , 6 ).…”

Best of ARM: Evaluating engagement in multisector community health networks: The case of tribal organizations

“…7 There are many recent examples of tribes collaborating with local governments and organizations in order to improve health in AI/AN communities. [19][20][21] Moreover, there is evidence that partners can still be valued even if mistrust exists between partners. 22 Therefore, we start with the assumption that most tribal organizations want to participate in local public health networks.…”

“…Nonetheless, tribal health authorities indicate forming partnerships as one of their top priorities to improve public health 7 . There are many recent examples of tribes collaborating with local governments and organizations in order to improve health in AI/AN communities 19–21 . Moreover, there is evidence that partners can still be valued even if mistrust exists between partners 22 .…”

Adapting to a Shifting Health Care Landscape: Illinois Breast and Cervical Cancer Program Lead Agencies’ Perspectives

“…Differences in cost and insurance coverage contribute significantly to disparities by affecting cancer screening uptake (Mukem, Meng, Sriplung, & Tangcharoensathien, 2015), and timing of detection (Kim, Chukwudozie, & Calhoun, 2013). The NBCCEDP was implemented to address these issues and ensure access for low-income, uninsured, and underserved women to breast and cervical cancer care (Eheman et al, 2014; Espey et al, 2014; Lantz & Mullen, 2015; Levano et al, 2014; Sanders et al, 2014; Yancy et al, 2014). NBCCEDP programs exhibit significant heterogeneity in implementation, including differences in which organizations participate/are engaged, staffing, and reimbursement processes (Lantz, Keeton, Romano, & DeGroff, 2004).…”