At the Mid-Michigan District Health Department a good example of this comes from the Breast and Cervical Cancer Control Program (BCCCP). Breast cancer remains one of the most common cancers diagnosed in women. Most forms of breast and cervical cancer are highly treatable if detected early enough. But low-income, uninsured women are not able to afford to be screened, resulting in cancers progressing to late stages before being detected and thus higher death rates. In 1990 Congress created the Breast and Cervical Cancer Control Program (BCCCP) providing money to States to help low-income, uninsured women gain access to breast and cervical cancer screening and diagnostic services. These services include—
- Clinical breast examinations.
- Pap tests.
- Pelvic examinations.
- Diagnostic testing if results are abnormal.
- Referrals to treatment.
The dilemma the State faces is that the funding for the program only enables it to offer BCCCP in full form to coordinating agencies in a couple of dozen communities across the state. The coordinating agencies’ budgets include staffing to manage the program and arrange for follow up care if it is required. If you are not one of the coordinating agencies you can participate in BCCCP but the only funding you get is a per-client payment that does not cover your costs.
In 2010, running an unsustainable deficit, we had to eliminate our BCCCP program. Before I go any further I need to say that it is a well-established fact in health research that distance to care is inversely related to outcomes. We see this both in rural areas, and in urban neighborhoods that have few providers. So the fact that Mid-Michigan women would have to get to Grand Rapids, Lansing or Saginaw for screening meant that some would not be able to do so, with the inevitable result that more would have untreatable cancers.
Amazingly, when they heard the program was being eliminated, Sparrow Clinton Hospital and MidMichigan Medical Center-Gratiot stepped in and provided funding to the tune of several thousand dollars each. Each year nearly a hundred and fifty women get screened and get follow up care if required, because of these generous partners. Unfortunately, not all low-income rural and urban communities have a provider in a position to be their benefactor.
My last word is about true prevention. Remember, most cervical cancers can be prevented by the HPV vaccine. It is important for boys and men, as well as girls and women to get the vaccine so they do not spread HPV to their partners. That’s a much better idea than an expensive screening program.