Cancer

Background

Cancer remains the second leading cause of death in both the U. S. and West Virginia, accounting for 23.5% of all deaths in the nation and 23.3% of all deaths in the state in 1995. The West Virginia Bureau for Public Health (WVBPH) has targeted breast, cervical, and lung cancer as priorities in determining the state's Healthy People 2000 goals.

The WV Breast and Cervical Cancer Screening Program (BCCSP). The BCCSP was established within the WVBPH in 1991 to provide screening services to low-income women who are uninsured or underinsured. In addition, the program provides education about breast and cervical cancers, quality assurance for mammography, cytology and clinical services, and monitoring of the incidence and mortality of these cancers in WV. The BCCSP is addressing Objectives 16.1-16.2.

The Coalition for a Tobacco-Free West Virginia. To combat the state's tobacco problem, the Coalition was formed in 1989 to serve as the implementation body for the WV Tobacco Control Program, located within the WVBPH. A five-year plan implemented in 1993 was developed by the coalition to reduce tobacco use and address Objective 16.3.

The Objectives

OBJECTIVE 16.1 Increase to at least 80% the proportion of women aged 40+ who have ever received a clinical breast examination and a mammogram, and to at least 60% those aged 50+ who have received them within the preceding one to two years.

UPDATE According to data from the Behavioral Risk Factor Surveillance System (BRFSS), the 1995 prevalence of 73.2% of women aged 40 and older who have ever had both a clinical breast examination and a mammogram extended an upward trend begun in 1990. At the present rate of increase, the year 2000 prevalence is expected to be 79.6%.

The prevalence of women aged 50 and older who had both a clinical breast examination and a mammogram within the preceding one to two years increased to 58.9% in 1995 (see Figure 2). If the present rate of increase continues, the target goal of 60% will be met.

OBJECTIVE 16.2 Increase to at least 95% the proportion of women aged 18 and older who have ever received a Pap test, and to at least 85% those who received a Pap test within the preceding two years.

UPDATE BRFSS data indicated that the 1995 prevalence of women aged 18 and older who had ever received a Pap test was 91.6%, a slight decline from 1994 (see Figure 3). At the current rate of increase, the year 2000 rate is projected to be 93.0%, not meeting the target goal of 95%.

The 1995 prevalence of women aged 18 and older who had a Pap test within the preceding two years was 71.8% (see Figure 4). Using BRFSS data from 1988 through 1995, the year 2000 prevalence is forecast to be 72.0%, far below the target goal of 85%.

OBJECTIVE 16.3 Reduce cigarette smoking to a prevalence of no more than 15% among West Virginians aged 18 and older.

UPDATE The 1995 prevalence of cigarette smoking among BRFSS respondents was 25.7%, a decline from 26.9% in 1994 (see Figure 5). The year 2000 rate is projected to be 24.0%, higher than the year 2000 goal of 15%.

Meeting the Objectives

The West Virginia Breast and Cervical Cancer Program located within the Division of Women's Services, WVBPH, and the West Virginia Tobacco Control Program (WVTCP), WVBPH, are the lead entities in addressing the objectives. They are joined in their efforts by the Coalition for a Tobacco-Free West Virginia, West Virginia Cancer Registry, American Cancer Society (WV Division), and West Virginia Cancer Advisory Committee. Together, these agencies and organizations are addressing the problem of cancer in the state by using the six health promotion channels to the communities listed in the box above (and discussed in greater detail in the Introduction). The program directors of the BCCSP and WVTCP, as well as the coordinator of the WV Cancer Registry, have been designated as plan coordinators.

In 1992, an amendment to the West Virginia Code expanded the West Virginia Breast and Cervical Cancer Incidence Registry to include all cancers, with the exception of basal cell and squamous cell carcinomas of the skin. The West Virginia Cancer Registry has become an essential tool in monitoring patterns and trends in cancer incidence and in evaluating the effectiveness of cancer programs in West Virginia.

To increase the proportions of women who receive clinical breast examinations and mammograms for breast cancer and Pap tests for cervical cancer, the BCCSP will work to:

• Provide high quality cancer screening services to West Virginia women, especially low-income women who are uninsured or underinsured.

• Educate women and their health-care providers about breast and cervical cancers.

• Under the direction of the BCCSP (and the program's coalition), describe and monitor long-term goals for reducing cancer mortality in the

• Utilize information provided by the WV Cancer Registry to monitor patterns of cancer incidence and mortality among state residents; identify geographic areas of unusual occurrence; help determine allocation of limited resources for state cancer control programs.

• Under the direction of the West Virginia Advisory Committee, advise and assist in carrying out effective cancer prevention and control activities for the state.

To address the problem of lung cancer in West Virginia, and to reduce the prevalence of cigarette smoking, the WVTCP will work with the Coalition and the American Cancer Society (WV Division) to:

• Build tobacco coalitions in every community.

• Strengthen public support for restricted access to tobacco to minors, including banning of cigarette vending machines, raising the legal age to purchase or possess tobacco products to 21, and licensing tobacco retail vendors.

• Support clean indoor air regulations.

• Increase economic incentives to discourage the use of tobacco products.

• Restrict advertising and promotion of cigarettes.

• Increase messages opposing tobacco use while decreasing messages supporting tobacco use.

• Increase the proportion of worksites with a formal smoking policy.

• Support policies advocating tobacco-free environments at public and private schools, public higher educational facilities, and vocational, technical, and trade schools.

Cancer
Meeting the Objectives

Lead Entities:
Breast and Cervical Cancer Program, WVBPH
West Virginia Cancer Registry, WVBPH
West Virginia Tobacco Control Program, WVBPH

Collaborating Entities:
Coalition for a Tobacco-Free West Virginia
American Cancer Society - WV Division
WV Cancer Advisory Committee

Plan Coordinators:
Nancye Bazzle, Program Director
Breast and Cervical Cancer Program
Office of Maternal and Child Health
(304) 558-5388/FAX (304) 558-2183

Beverly Keener, RN, MPH, CTR
Cancer Surveillance Coordinator, WV Cancer Reg.
Office of Epidemiology and Health Promotion
(304) 558-5358/FAX (304) 558-4463

Billie Wiant, Program Manager
WV Tobacco Control Program
Office of Epidemiology and Health Promotion
(304) 558-0644/FAX (304) 558-1553

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