Provision Of Screening Services Research Articles

English

Elevated level of cholesterol is a risk factor for the development of cardiovascular disease. Community pharmacies are considered as ideal settings to provide screening services for chronic medical conditions. An adequate knowledge and a positive attitude towards cholesterol screening would increase pharmacist’s involvement in cholesterol lowering interventions and referrals. The objective of this study was to assess community pharmacists’ knowledge, attitude and resource availability in relation to cholesterol screening in Delta State, Nigeria. A 33 item pre tested self-administered questionnaire with a Cronbach’s alpha value of 0.628 was distributed to all 160 community pharmacists in Delta State. The questionnaire items assessed knowledge, attitude and available resources in relation to cholesterol screening. Categorical data was expressed as frequency and percentages. Chi-square test was performed to explore relationship between demographic variables and pharmacist’s knowledge. A p-value of less than 0.05 was considered statistically significant. More than half (64.7%) of community pharmacist were knowledgeable in relation to cholesterol and its influence on cardiovascular diseases. Cholesterol screening services were provided by only 11.3% community pharmacies in Delta State. Majority (82%) were willing to be trained in the use of cholesterol meter. Nearly half, 42.9% had a negative attitude towards cholesterol screening. Pharmacist’s knowledge about cholesterol and its influence in cardiovascular diseases was satisfactory. However, attitude towards cholesterol screening was largely negative and provision of such services was very low. Key words: Cholesterol screening, community pharmacies, knowledge, Nigeria.

Examining differences between P1 versus P2 students as teaching assistants in a P1 skills-based course

IntroductionThe purpose of this study was to assess differences between the use of first-year (P1; “peer”) versus second-year (P2; “near-peer”) students as teaching assistants (TA) in a first-year, skills-based course. MethodsThe practicum course assesses competence in the provision of screening services and patient counseling. TAs review weekly material followed by a one-on-one assessment of each student using a grading rubric. Both qualitative and quantitative data were analyzed to determine if there was a difference in performance between the peer and near-peer teaching assistants. ResultsSixteen peer and 33 near-peer TAs were evaluated by 210 students for six different skill assessments in practicum. There was no significant difference between peer and near-peer TAs in both student perception of TA performance and in TA grading of student performance. ConclusionsThere is no difference in the use of peer versus near-peer TAs in evaluating first-year pharmacy students in the skills-based course. Using peer TAs over near-peer TAs can be useful when faced with scheduling and other resource conflicts.

A Modeling Framework for Control of Preventive Services

We present a modeling framework for facilities that provide both screening (preventive) and diagnostic (repair) services. The facility operates in a random environment that represents the condition of the population that needs screening and diagnostic services, such as the disease prevalence level. We model the environment as a partially endogenous process: the population’s health can be improved by providing screening services, which reduces future demand for diagnostic services. We use event-based dynamic programming to build a framework for modeling different kinds of these facilities. This framework contains a number of service priority policies that are concerned with prioritizing screening versus diagnostic services. The main trade-off is between serving urgent diagnostic needs and providing screening services that may decrease future diagnostic needs. Under certain conditions, this trade-off reverses the famous cμ rule; i.e., the patients with lower waiting cost are given priority over the others. We define appropriate event operators and specify the properties preserved by these operators. These characterize the structure of optimal policies for all models that can be built within this framework. A numerical study on colonoscopy services illustrates how the framework can be used to gain insights on developing good screening policies.

Infection Prevention - Visitors and the Best of Intentions

Preventing the spread of infectious diseases in a BMT inpatient unit is challenging but has been shown to save lives. Inpatient units are under constant threat from outside contagions in the form of visitors and caregivers. Screening each visitor to determine their degree of appropriateness for visiting from an infectious diseases standpoint requires a staffing model that is hard to implement. The challenge is how to identify and reduce infectious risks to our immunocompromised/immunosuppressed BMT patient population. The inpatient unit does not have dedicated intake staff and front desk staff arenot able to provide screening services. Visitors and caregivers do not want to delay their visits despite their potential contagion, often without realizing the threat their sickness may pose to their loved ones as well as to other patients on the unit. Visitors, caregivers, and the patients themselves, are often reluctant to wear a mask. A multi-disciplinary round table discussion was held with registration staff, clinical staff, Infection Control, Risk Management, and Quality Control. An educational rollout was implemented for staff to emphasize use of masks, hand hygiene and isolation, adherence to universal precautions, droplet precautions, precautions during aerosol-generating procedures, and environmental cleaning and disinfection per established protocols. Large, free standing signs were placed at the entrance to the units asking guests to read through the list of symptoms and potential threats (per FACT standard B2.2). If free from any of the symptoms or threats listed, guests were asked to take one of the stickers provided that announce “I am safe to visit”. The color of the sticker changed each day of the week ensuring visitors (including caregivers who may spend the night on the unit) were re-screened daily. Employees had access to stickers and were instructed to stop anyone on the floor without a visible sticker on their person. The stickers were found to be an effective tool for self-screening. The staff was not additionally burdened and found it easy to identify those who might be an infectious risk to the unit. The process was extended to the outpatient units. The process proved an effective tool for screening and reinforced the education given to guests, families, caregivers, and patients about the importance of prevention of infections.Image 2: Inpatient Sign with Stickers.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Image 3: Sign Details.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Vision Impairment and Ocular Morbidity in a Refugee Population in Malawi.

To provide screening services and obtain information on the eye health status and distribution of visual impairments in a refugee population of the sole refugee camp in Malawi. A general eye screening at Dzaleka refugee settlement camp was organized in November 2012. Final-year optometry students conducted detailed optometry examinations, including visual acuity (VA) assessment for near and distance, retinoscopy, and subjective refraction in cases with distance VA less than 6/12 or near VA less than N8, anterior and posterior segment evaluation. Their findings were then verified by an optometrist. The World Health Organization definition of vision impairment was followed, and the cause of vision impairment was determined at the end of each examination. Where possible, participants requiring refractive correction were provided spectacles free of cost. Of a total 635 participants examined, around one-half were male with 61% in the 16 to 49 years age group. The overall prevalence of presenting blindness, severe vision impairment, and vision impairment were 1.3% (95% confidence interval [95% CI], 0.5 to 2.4), 0.5% (95% CI, 0.0 to 1.1), and 3.6% (95% CI, 2.3 to 5.2), respectively. Overall vision impairment (VA <6/18) was present in 5.4% (95% CI, 3.6 to 7.1) of the participants. The principal causes of blindness, severe vision impairment, and vision impairment were cataracts, refractive errors, and corneal opacities, respectively; and more than 90% of the overall vision impairment was avoidable. Refractive errors and presbyopia were the most common morbidity, present in more than two-thirds of the participants examined. Only 5% of all the participants ever had a previous eye examination. The prevalence and causes of blindness and vision impairment in a refugee population are comparable with those of the general population. Lack of basic eye care services in the health center for refugees is a major concern. The health care facility in the settlement camp needs to be upgraded to provide comprehensive eye care including refractive care services.

Survey of Participation in Organised Cervical Cancer-Screening Programme in Hungary.

Cervical cancer mortality is high in Hungary, with more than 400 deaths per annum. In 2003, a national cervical cancer screening programme was launched to provide screening services for women who otherwise would not use services themselves. The aim of this survey was to study the socioeconomic and lifestyle factors related to participation in the organised cervical cancer screening programme. A questionnaire-based health survey was conducted using a representative sample of women from 25-65 years of age in 11 Hungarian counties. A logistic regression analysis was used to study the association between participation in the screening programme and socioeconomic and lifestyle factors. 74% (95% CI: 70-77%) of the target population underwent a screening examination within the previous three years. Only 15% (95% CI: 5-35%) of the women, who received an invitation letter and took part in the organised screening programme, had never been previously examined by gynaecologist. The participation rates decreased significantly (p<0.05) for those subjects aged >44 years, retired, participants with low income, living in small settlements, and reported to be heavy smokers. Although the overall proportion of Hungary's population that undergoes regular screening for cervical cancer is not low, the organised national cancer screening programme was ineffective in engaging women not regularly visiting their gynaecologist for examination.

Utilizing Walgreen’s World-AIDS Day as an Intervention in St. Louis

Eight pharmacy student members of the STLCOP SNPhA chapter coordinated and facilitated the HIV/AIDS health fairs. Students set up a table in a Walgreens location which the concentration of HIV/AIDs cases are estimated by the Center for Disease Control and Prevention (CDC) to be the highest [3]. The table contained educational brochures, gift cards, awareness wrist bands and red ribbons. Customers were given the opportunity to win a Walgreens gift card by answering 6 out of 10 HIV/AIDs related questions correctly. Walgreens presented small bags filled with store-branded items to customers who stopped by the table. The STLCOP SNPhA chapter will continue to partner with Walgreens and provide screening services and education to St. Louis residents in efforts to improve the health and wellness of the community.

Breast cancer screening of underserved women in the USA: results from the National Breast and Cervical Cancer Early Detection Program, 1998-2012.

To describe the number and proportion of eligible women receiving mammograms funded by the National Breast and Cervical Cancer Early Detection Program (NBCCEDP). Low-income, uninsured, and underinsured women aged 40-64 are eligible for mammography screening through the NBCCEDP. We used data from the NBCCEDP, the Current Population Survey, and Medical Expenditure Panel Survey to describe the number and proportion of women screened by the NBCCEDP and overall. In 2011 and 2012, the NBCCEDP screened 549,043 women aged 40-64, an estimated 10.6 % (90 % confidence interval [CI] 10.4-10.9 %) of the eligible population. We estimate that 30.6 % (90 % CI 26.4-34.8 %) of eligible women aged 40-64 were screened outside the NBCCEDP, and 58.8 % (90 % CI 54.6-63.0 %) were not screened. The proportion of eligible women screened by the NBCCEDP varied across states, with an estimated range of 3.2 % (90 % CI 2.9-3.5 %) to 52.8 % (90 % CI 36.1-69.6 %) and a median of 13.7 % (90 % CI 11.0-16.4 %). The estimated proportion of eligible women aged 40-64 who received mammograms through the NBCCEDP was relatively constant over time, 11.1 % (90 % CI 10.2-11.9 %) in 1998-1999 and 10.6 % (90 % CI 10.4-11.9 %) in 2011-2012 (p = 0.23), even as the number of women screened increased from 343,692 to 549,043. Although the NBCCEDP provided screening services to over a half million low-income uninsured women for mammography, it served a small percentage of those eligible. The majority of low-income, uninsured women were not screened.

"Test, Listen, Cure" (TLC) Hepatitis C Community Awareness Campaign.

BackgroundImproved drugs have been approved for the treatment of hepatitis C virus (HCV), but many people are unaware of improved therapies that are now available to cure the illness in a high percentage of patients.ObjectiveThe objectives of the Test, Listen, Cure (TLC) Hepatitis C Community Awareness Campaign include the development and implementation of a health education and promotion campaign in Memphis, Tennessee, and surrounding areas of western Tennessee, eastern Arkansas, and northern Mississippi, to increase community awareness about HCV, and to provide up-to-date provider education on HCV screening and treatment. The health education and promotion campaign, which will be conducted in collaboration with area hospitals, clinics, and nonprofit organizations, will provide information about how HCV infection is transmitted, risk factors for the disease, the importance of screening and treatment, and the availability of improved treatment for the disease. A second objective will be to provide continuing professional education on HCV screening and treatment to a minimum of 200 area health care providers, including primary care and internal medicine physicians and residents, physician assistants, nurse practitioners, providers who care for homeless persons, and dialysis unit nurses.MethodsHealth education materials will be developed for this community awareness campaign that is culturally appropriate for African Americans and suitable for people with lower health literacy and educational attainment. Information will be compiled and disseminated about area providers who provide screening services and treatment for persons with HCV in order to facilitate linkages to care. Four focus groups of 8-10, African American adults aged 40-64, will be conducted to test the health education materials. The provider education on HCV will also address patient-physician communication and cultural competency. The National Medical Association regional chapters and expert physician consultants will provide assistance with delivering the education program.ResultsResults from this one year project will be available in early 2016.ConclusionsDepending on the availability of funding and successful implementation of the project, the TLC campaign will be extended to similar cities in the United States.

CONTROVERSIES IN LUNG CANCER SCREENING IN OLDER PATIENTS

The National Lung Screening Trial found a 20% decrease in lung cancer-specific mortality using low-dose computed tomography to screen individuals with a 30 pack-year history of smoking, aged 55–75 years. Increasing age is an independent risk factor for lung cancer. Thus, elderly patients stand to benefit the most from low-dose computed tomography screening. Based upon the peak age of lung cancer diagnosis, currently 71 years, screening until at least the age of 79 years will continue to provide benefit to the healthy elderly who have largely outlived their birth cohort. Consideration for low-dose computed tomography in older elderly individuals should be based upon functional status and reserve on a case-by-case basis. These adaptations are contained within the 2012 American Association for Thoracic Surgery Lung Cancer Screening Guidelines. The United States Preventive Services Task Force (USPSTF) voted in favor of low-dose computed tomography (LDCT) screening between ages 54–80 for 30 pack year smokers, because of this final recommendation published in 2013, private insurance plans, including those created under the Affordable Care Act, must cover lung cancer screening by January 1st, 2015. This recommendation also encourages Medicaid plans to provide screening services with no cost sharing; however, Medicare is not required to follow this recommendation. Instead, Centers for Medicare & Medicaid Services (CMS) reanalyzed the service, its presumed benefit, and potential risk to make a National Coverage Determination. The Medicare Evidence Development & Coverage Advisory Committee (MEDCAC) met in April 2014, and disagrees with the screening recommendation. They believe, despite overwhelming evidence from NLST, that there is not have enough confidence in the available data to safely recommend screening knowing that the main benefit may not outweighed the potential harm. Disclosure of interest: None declared

From cancer screening to treatment: service delivery and referral in the National Breast and Cervical Cancer Early Detection Program.

The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) provides breast and cervical cancer screening and diagnostic services to low-income and underserved women through a network of providers and health care organizations. Although the program serves women 40-64 years old for breast cancer screening and 21-64 years old for cervical cancer screening, the priority populations are women 50-64 years old for breast cancer and women who have never or rarely been screened for cervical cancer. From 1991 through 2011, the NBCCEDP provided screening and diagnostic services to more than 4.3 million women, diagnosing 54,276 breast cancers, 2554 cervical cancers, and 123,563 precancerous cervical lesions. A critical component of providing screening services is to ensure that all women with abnormal screening results receive appropriate and timely diagnostic evaluations. Case management is provided to assist women with overcoming barriers that would delay or prevent follow-up care. Women diagnosed with cancer receive treatment through the states' Breast and Cervical Cancer Treatment Programs (a special waiver for Medicaid) if they are eligible. The NBCCEDP has performance measures that serve as benchmarks to monitor the completeness and timeliness of care. More than 90% of the women receive complete diagnostic care and initiate treatment less than 30 days from the time of their diagnosis. Provision of effective screening and diagnostic services depends on effective program management, networks of providers throughout the community, and the use of evidence-based knowledge, procedures, and technologies.

Exploring the General Practitioner–pharmacist relationship in the community setting in Ireland

To explore the General Practitioner (GP)-pharmacist relationship, to gain insight into communication between the professions and evaluate opinion on extension of the role of the community pharmacist. A postal questionnaire sent to 500 GPs and 335 community pharmacists with work addresses in the counties of Cork, Kerry, Tipperary, Waterford and Limerick, Ireland. An overall response rate of 56% was achieved. Clear differences of opinion exist between GPs and pharmacists on the extension of the role of the community pharmacist; pharmacist provision of vaccinations (12% of GPs in favour versus 78% of pharmacists), pharmacists prescribing the oral contraceptive pill (18% GP versus 88% pharmacist) and increasing the prescribing power of the pharmacist (37% GP versus 95% pharmacist). Fifty-four percent of GPs and 97% of pharmacists were in favour of pharmacists providing screening services, while 82% of GPs and 96% of pharmacists were in favour of pharmacists dealing with minor ailments. Seventy-three percent of GPs and 43% of pharmacists agreed that communication between the professions was very good. This study identifies a clear difference of opinion on the extension of the role of the community pharmacist and recognises problems in communication between the professions. This comes on the background of continued calls from the Pharmaceutical Society of Ireland for an extension of pharmacist roles and continued opposition from the Irish Medical Organisation to such moves. This study highlights the need for increased dialogue between representative organisations and a commitment for professional agendas to be set aside in the best interests of patients.

Funding and administrating airport screening in Canada: A transportation policy like the others?

Political science has studied airport security and screening in reference to notions such as governmentality and surveillance or power and technology. This article uses the tools of policy analysis in order to demonstrate that understanding airport screening policy in link with other air transportation policies (such as airport economics policy, international air policy or air carrier ownership and control policy) highlights the core elements, rationales and logic behind the provision of screening services. It is argued that the core elements of transportation policies at large are identical to the core elements of airport screening policy, and that both have been reframed, reshaped and reoriented in the past decades in order to accompany the liberalization of air transport. If airport screening policy has been reformulated in the aftermath of the 9/11 Attacks, the core elements of a market-oriented airport screening policy has not been challenged.

Validity of Vision Screening Tests by Teachers Among School Children in Mashhad, Iran

Purpose: To determine the sensitivity and specificity of vision screening in Iranian schools where teachers have provided screening services for over 10 years.Methods: In a cross-sectional study, using random cluster sampling, 1163 school children were selected from 14 clusters. Data of vision tests performed by teachers were derived from 847 student records and compared with data obtained by optometrists. Measurement of the uncorrected visual acuity was done using the E chart by both the teachers and the optometrists. Examinations performed by optometrists were regarded as gold standard in this study and the sensitivity and specificity of the examinations performed by teachers were evaluated against them. Uncorrected visual acuity worse than 20/25 in the better eye was considered as the cut-off point for students’ visual impairment.Results: The sensitivity and specificity of the screening tests performed by the teachers were 37.5% and 92.0%, respectively. The positive and negative predictive values were 25.0% and 95.4%, respectively. There was no significant difference in the validity of the vision test between males and females (P = 0.093 for sensitivity and P = 0.052 for specificity).Conclusion: Our findings showed that teachers missed a significant number of children with vision impairment and the examinations performed by teachers lacked the required sensitivity for case detection. The number of false negative results should be minimized through continued investment in accurate screening processes.

Accessibility and screening uptake rates for gestational diabetes mellitus in Ireland

Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with onset or first recognition during pregnancy and is associated with a range of maternal and neonatal complications and conditions. Given increasing levels of prevalence worldwide, there are growing calls for the implementation of screening practices to identify and treat positive GDM cases. This paper uses a unique dataset to investigate the role of healthcare centre accessibility on the decision to attend for screening, employing geographic information systems, econometric and simulation techniques. We focus on the extent to which ‘travel distance to screening hospital site’ impacts upon the individual's screen uptake decision, whether significant geographic inequalities exist in relation to accessibility to screening, and the likely impact on uptake rates of providing screening services at a local level via primary care. Our findings have important implications for the provision of GDM screening services.

Abstract B13: Lessons learned from implementing a prostate cancer risk assessment program for underserved high-risk men: The Prostate REACH Project

Abstract Background: Prostate cancer disproportionately affects Black men. Black men are 60% more likely to be diagnosed with prostate cancer and 2.4 times more likely to die from prostate cancer compared to White men. Therefore, prostate cancer risk assessment programs are important to assess risk, discuss risks and benefits of screening, and provide screening services. However, Black men may encounter barriers to participation in these programs such as lack of health insurance, difficulty with travel to clinic, and challenges with navigating the medical system. To address these barriers, the Prostate Cancer Risk, Education and Assessment in the Community with Help (REACH) project was developed as a community-based extension of a comprehensive prostate cancer risk assessment program (PRAP) at Fox Chase Cancer Center (FCCC). This is a pilot project to evaluate the feasibility and acceptability of a community-based risk assessment program. Methods: Developing the REACH project infrastructure included: 1) choosing a clinic site; 2) establishing patient access procedures; 3) establishing navigator services; 4) developing procedures for subsidy fund use; and 5) recruitment and promotion. Given the challenges of establishing a community site, we chose to utilize our mobile mammography van as the screening venue. Evaluation measures included recruitment and participation rates, utilization of patient navigation services, as well as patient satisfaction. A self-administered survey assessed the distance travelled to receive screening services, whether or not they utilized patient navigator services, the importance of having a community screening site in their decision to participate (5-point Likert scale), the importance of having a patient navigator to assist (5-point Likert scale), satisfaction with any patient navigation services provided (5-point Likert scale), and overall satisfaction with the program (5-point Likert scale). Results: As of April 2011, 35 men have called regarding the program. Of these, 20 were eligible and 13 men have received prostate cancer risk assessment services through Prostate REACH. Twelve participants were screened on the van and one patient at the FCCC PRAP clinic. The majority of participants are Black men. The mean age at enrollment is 48.6 years (range 36–64 years). Approximately 69% of participants received patient navigation services. The patient navigator contacted each participant on average three times to address barriers. Insurance issues were the most common barrier (88%) addressed by the navigator. Support issues (emotional and caregiver) also were addressed. All participants completed the user survey following their screening. Nearly 70% of men travelled five miles or less to be screened, and 54% reported that they utilized patient navigation services (slightly under the 69% who actually did receive some navigation). The majority of participants thought having a community screening location and a patient navigator was important for participation. The majority of participants were quite a bit to extremely satisfied with the overall REACH program (Mean=4.85, SD=0.38). Conclusions: The REACH experience highlights specific implementation challenges faced in expanding access to prostate cancer risk assessment to underserved men. Patient navigation services may be essential to participation among underserved populations. Future research should explore various recruitment strategies to increase participation. Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):B13.

Meeting the mammography screening needs of underserved women: the performance of the National Breast and Cervical Cancer Early Detection Program in 2002–2003 (United States)

ObjectiveTo examine the extent to which the National Breast and Cervical Cancer Early Detection Program (Program) has helped to meet the mammography screening needs of underserved women.MethodsLow-income, uninsured women aged 40–64 are eligible for free mammography screening through the Program. We used data from the U.S. Census Bureau to estimate the number of women eligible for services. We obtained the number of women receiving Program-funded mammograms from the Program. We then calculated the percentage of eligible women who received mammograms through the Program.ResultsIn 2002–2003, of all U.S. women aged 40–64, approximately 4 million (8.5%) had no health insurance and had a family income below 250% of the federal poverty level, meeting Program eligibility criteria. Of these women, 528,622 (13.2%) received a Program-funded mammogram. Rates varied substantially by race and ethnicity. The percentage of eligible women screened in each state ranged from about 2% to approximately 79%.ConclusionsAlthough the Program provided screening services to over a half-million low-income, uninsured women for mammography, it served a small percentage of those eligible. Given that in 2003 more than 2.3 million uninsured, low-income, women aged 40–64 did not receive recommended mammograms from either the Program or other sources, there remains a substantial need for services for this historically underserved population.

Can Trained Health Educators Provide Screening, Brief Intervention and Referral Services in an Academic Teaching Hospital Emergency Department?

Can Trained Health Educators Provide Screening, Brief Intervention and Referral Services in an Academic Teaching Hospital Emergency Department?

Effectiveness of a mobile medical van in providing screening services for STDs and HIV.

This retrospective study assesses the efficacy of a mobile medical van in screening high risk individuals and identifying new cases of HIV and other sexually transmitted diseases (STDs) in an urban setting from July 1996 through March 1997. High risk sex and drug use were common, while consistent condom use was rare. Relatively few patients were screened for STDs; positive cases represented only a small proportion of the STD cases identified in the study community. The mobile program, however, accounted for 11.5% of all HIV tests conducted at public test sites in the city. Mobile medical programs have the potential to improve STD and HIV control efforts by providing services to high risk individuals who may lack access to care elsewhere. Doing so, however, will require more active case finding techniques, including new, less invasive techniques to test asymptomatic individuals.

SIEGEL ET AL. RESPOND

In our article, we presented the results of a study from which we concluded that a change in the 1992 BRFSS questionnaire wording caused a reduction in the measured prevalence of mammography screening, especially among Black women and women with less than a high school education. Berumen points out that the Breast and Cervical Cancer Mortality Prevention Act, passed by Congress in 1990, may have increased mammography use among low-income women and thereby caused some of the effect that we attributed to questionnaire wording. It is important to recognize that although the Prevention Act was passed in 1990, screening programs implemented on the basis of this legislation developed gradually. Specifically, funding began in 1991 and was initially received by only 8 states. Few services were delivered by these funded states before mid-1992, so we believe it is highly unlikely that the Prevention Act had any effect on the results of our study. To further put into perspective the population-based impact of this legislation, we would like to point out that even in 2001, the Centers for Disease Control and Prevention’s Division of Cancer Prevention and Control estimated that about 18% of the Prevention Act’s target population received screening through Prevention Act funds, since appropriations were not available to provide screening services to additional women.