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1993.06.21 : National Strategic Plan

Contact:  CDC Press Office  (404) 639-3286
Monday, June 21, 1993         

       HHS Secretary Donna E. Shalala today released a national
plan to dramatically reduce breast and cervical cancer deaths
through coordinated government, private sector and volunteer
efforts.
       The National Strategic Plan for the Early Detection and
Control of Breast and Cervical Cancer aims at reducing breast
cancer deaths by 30 percent and cervical cancer deaths by 90
percent through increased use of mammogram screening and pap
smears.
       Secretary Shalala pledged the "best efforts" of three U.S.
Public Health Service agencies -- the Centers for Disease Control
and Prevention in Atlanta, the National Cancer Institute and the
Food and Drug Administration -- to the partnership effort, which
includes such major voluntary organizations as the American Cancer
Society.  About 75 organizations, including government agencies,
are pledged to work together on the project.
       Secretary Shalala said, "Many women are so fearful that we
postpone getting tests.  Our coalition's job is to show women that
these tests can be lifesaving and can reduce the likelihood of
disfigurement and pain."  
       The plan seeks to increase to at least 80 percent the number
of women aged 40 and older getting mammograms, as well as increase
the use of the Pap test.  Only 41 percent of women above age 40
follow the recommended guidelines for breast cancer screening, and
the likelihood of having a mammogram decreases sharply to only 12
percent among women over age 59.  Risk of breast cancer increases
significantly with age.
       Without action to increase high quality screening and
follow-up services, breast and cervical cancer will take the lives
of more than one-half million women during the 1990s.  For both
types of 
cancer, it is poor, elderly and minority women who are least likely
to be screened.  Mortality rates are disproportionately high among
these groups despite the fact that proven tools exist for early
detection.
       The plan calls for greater access to screening services,
increased education of women and health care providers, and
improved quality assurance measures for screening mammography and
cervical cytology.
       The strategic plan represents a national framework in which
there are major roles for federal, state and local governments;
national organizations; the private sector; and the general public. 
The plan includes six major components:
o    Integration and coordination--providing better access to
     screening services, closing gaps in follow-up services
     (including diagnostic and treatment services), and
     establishing mechanisms to fulfill other plan components.

o    Public education--meeting the information needs of the public
     to ensure that women are aware of the importance of screening
     and the availability of care.

o    Professional education and practice--addressing the
     information and continuing education needs of health
     professionals to ensure effective screening and appropriate
     follow-up referrals.

o    Quality assurance for breast cancer screening--ensuring
     consistent, high-quality breast cancer screening throughout
     the entire process of obtaining, interpreting and reporting
     mammogram results.

o    Quality assurance for cervical cancer screening--ensuring
     consistent, high-quality cervical cancer screening throughout
     the entire process of obtaining, interpreting and reporting
     Pap smear results. 

o    Surveillance and evaluation--assessing whether programmatic
     efforts are achieving the desired results:  increasing the
     number of women screened for these cancers, identifying their
     cancers earlier and reducing women's fatalities. 

       The Centers for Disease Control and Prevention, the National
Cancer Institute, and the Food and Drug Administration coordinated
the development of the plan.  In 1993, CDC entered into the third
year of a national breast and cervical cancer mortality
prevention program that will direct $71.3 million to support 30
state health agencies in developing an effective public health
infrastructure system for breast and cervical cancer screening and
follow-up services as mandated by the Breast and Cervical Cancer
Mortality Prevention Act of 1990.  
       The current National Cancer Institute's breast and cervical
cancer screening recommendations are as follows:
       Breast cancer screening should begin at the age of 40. 
Beginning at age 50, both a clinical breast examination and
screening mammogram should be obtained annually.  Screening
guidelines apply only to asymptomatic women.  The frequency and
type of examination for symptomatic women will vary and should be
determined by a responsible health care provider. 

       Additionally, all women who are or who have been sexually
active or who are at least 18 years old should have an annual Pap
test and pelvic examination.  After a woman has had three or more
normal annual examinations, the Pap test may be performed at the
discretion of her health care provider. 


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