The Significance of Cancer Screening Cancer is the second leading cause of death in the United States next to heart disease. There were about more than 575, 000 people died of cancer in 2011. More than 1.5 million diagnosed with cancer as per United States Cancer Statistics 1999-2011, Incidence and Mortality Web-based Report (CDC, 2015, p.1). With the increasing rate of cancer, the government created several programs to save the lives of the people. Cancer screening like Papanicolaou smear and breast exam to all Americans can reduce the incidence of cancer and deaths (CDC, 2015, p.2).
Every Woman Matters Program Every Woman Matters (EWM) is a federally funded program designed to remove barriers to preventive breast and cervical cancer screening by providing public awareness of the risk women population. EWM also make screening more financially accessible to women who have low-income or no health insurance. EWM program also pays the following check-ups with associated tests like clinical breast examination, Papanicolaou smear, and mammography. They pay at reduced price or no cost to eligible women who are 40 to 74 years of age (Backer et al., 2005, p. 401). These tests will detect early stages of cancer, prevent progression, save lives, reduce health care cost and suffering. A case study was made to see the effectiveness of screening for breast and cervical cancer in Nebraska. However, even with these EWM program, it remained suboptimal despite their awareness and implementation to assist low-income women (Backer et al., p.402). The purpose of this paper is to discuss the barriers and possible reasons why the EWM program was ineffective. In this paper, it will also describe the two successful preventive programs that advocate for early screening and shows some strategies to create a more efficient program.
Reasons of EWM Program Ineffectiveness The GAPS model was used in this case study to identify and reduce the barriers to breast and cervical cancer screening services. A research nurse collected the qualitative and quantitative data from seven primary care services, then did analysis and cross-comparison of each practice (Backer et al., p.401). There were several reasons that made the program ineffective. Most of the care practice plans for change had many similarities like developing screening database and reminder system (Backer et al., p. 401). Organizational cohesiveness, leadership, and teamwork abilities were the main reasons for ineffectiveness. There was nobody assumed the responsibility and accountability for the job implementation, and there was no cooperation and team effort among the staff. Practice diversity in their mission and different individual personalities of health care providers and staff also caused the ineffectiveness. Each practice had different outlook or vision in meeting their needs. There was a tension between the doctors and nurse practitioners. Staff resistance to the added efforts required for change was one of the causes of ineffectiveness. The staffs overwhelmed with their job, and they already had a lot of work. Adding more responsibility with EWM program was burdensome for them. Complex organizational systems and availability of resources to practice contributed to ineffectiveness. It affected the decision-making because they didn’t have autonomy to decide as higher authority controlled them. They could only use limited resources or whatever it was available (Backer et al., p. 407). Practice No.1 was the only practice that showed greater flexibility because of the increase documentation of both mammograms, 23.3% to 60.4% and Papanicolaou smears, 17.6% to 67.8 %. It was a bit effective because of the involvement of the office manager who led the effort, despite no physician leadership (Backer et al., p. 403).
Preventive Programs That Advocate for Early Screening There are several successful programs that are created to detect, prevent, and control breast and cervical cancer. The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) is a program that provides access to breast and cervical cancer screening to underserved women in all 50 states. It helps low-income, uninsured, and underinsured women to have screening and diagnostic services like mammograms, Papanicolaou tests, clinical breast exams, and pelvic exams. This program provides cervical cancer screening for women ages 21 to 64 years old. It also provides breast cancer screening for women ages 40 to 64 years old. Approximately 11.1% of women were eligible for cervical screening and about 9.8% qualified for breast screening. The program provided 6.5% of eligible women for cervical cancer screening and also served 10.6% of those qualified for breast cancer screening. Since 1991, the NBCCEDP had provided more than 11.8 million breast and cervical cancer screening exams to more than 4.7 million women in all 50 states of United States of America (CDC. 2015a). NBCCEDP provides follow-up services for women with abnormal screening results and makes referrals if diagnosed with cancer. NBCCEDP is a population-based program that supports public health education, quality assurance, case management, outreach, and program evaluation that increased the effectiveness of screening programs (CDC. 2015b). This program only proves that NBCCEDP significantly improved the chances of survival for many women who are at risk for cancer. The Icelandic breast cancer screening program is a population-based study started in November 1987 in Reykjavik, Iceland and covered the whole country from 1989 till 2010. The purpose of the program was to estimate the impact of mammography service screening in Iceland on deaths from breast cancer. The cost effective mammography was provided with cervical cancer screening among all women who were 40 to 69 years old with two years interval. There were 33,985 women in 1988 and 54,714 women who undergone screening program. Cancer Detection Clinic read all mammograms. Screen-detected women with abnormal findings like small tumors recalled for further workups such as biopsies and ultrasound. Further referrals to oncologist made for those who were positive for malignant cells. The study confirmed a 41% decrease in the mortality rate for all age group after the initial screening. These results were consistent for 22 years screening period that made it successful (Sigurdsson, et al., 2013, p. 17).
Strategies for More Effective Prevention Program Strategies are crucial in creating a more effective prevention program. As a nurse leader, we play a pivotal role in creating such strategies to effectively follow-up the Every Woman Matters program. Giving incentives or rewards to staff members involved in screening program will make them more worthy and efficient worker. Community involvement is also crucial in planning and implementation of the program. Educating people on cancer awareness and how to lower their cancer risk is an imperative strategy. Providing pictures and presentations to underserved communities will easily understand the program. Working with other groups and community leaders to make sure people have the services and information they need is also important. Spread the word by working with media in the community is also an effective strategy. We can use social media like Twitter and Facebook in disseminating the information in preventing cancer (CDC. 2012. p.1). With these strategies, working hand in hand with the community will surely succeed the program.
Summary
Every Woman Matters is a program designed to prevent breast and cervical cancer by providing public awareness of the risk women population. However, it remained ineffective despite the implementation to assist the underserved women in Nebraska (Backer et al., p. 401). To have effective cancer screening program, it all depends on the patient, provider, and healthcare system factors. If there is an active participation of the health care team and the high-risk population involved will surely get a positive result. The initiative, determination, and collaboration with other team members will make the program succeed.

References

Backer, E. L., Geske, J. A., McIlvain, H. E., Dodendorf, D. M., & Minier, W. C. (2005). Improving female preventive health care delivery through practice change: An Every Woman Matters study. Journal of the American Board of Family Practice, 18(5), 401–408.
Centers for Disease Control and Prevention. (2015a). National Breast and Cervical Cancer Early Detection Program (NBCCEDP). March 2015. Retrieved from http://www.cdc.gov/cancer/nbccedp/about.htm
Centers for Disease Control and Prevention. (2015b). Addressing the Cancer Burden at a Glance. February 2015. Retrieved from http://www.cdc.gov/chronicdisease/resources/publications/AAG/dcpc.htm
Centers for Disease Control and Prevention. (2012). The Road to Better Health. A Guide to Promoting Cancer Prevention in your Community. December 2012. p.1. Retrieved from http://www.cdc.gov/cancer/dcpc/pdf/CancerToolKit.pdf
Sigurdsson, K., Olafsdottir, E.J., (2013), Population-based service mammography screening: The Icelandic experience. Dove Press Journal, May 2013. Vol. 5. P. 17-15. Retrieved from http://www.dovepress.com/population-based-service-mammography-screening-the- icelandic-experienc-peer-reviewed-article-BCTT