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Prevention & Early Detection
Objectives | Current Activities | Accomplishments | Resources


Goal: Reduce cancer morbidity and mortality by increasing awareness and screening rates for those cancers where evidence-based guidelines exist.

Co-Chairs
Dr. Lynn Butterly, Dartmouth Hitchcock Medical Center
Karen Bugler, NH Dept. of Health & Human Services

People can reduce their risk of getting some cancers by following recommended screening guidelines. Screenings can find cancers at an early stage, which can increase the available treatment options and decrease mortality rates for breast, cervical, and colorectal cancers. Colorectal and cervical cancer screening can find changes early and prevent cancer from developing.

In New Hampshire, the prevention and early detection work group has focused its efforts on:

  • Colorectal cancer. Because individuals have access to several available screening options that can be effective in preventing colorectal cancer, it is critically important to increase New Hampshire’s screening rates and, therefore, prevention and early diagnosis of this disease. Even though early diagnosis and treatment of colorectal cancer can result in a five-year survival rate of 90%, only about 47% of colorectal cancers in New Hampshire were diagnosed at the early stage in 2006.

    Toward the goal of screening 80% of New Hampshire residents who are 50 and older for colorectal cancer, DHMC (with partners in the NH CCC and NH DPHS) in 2009 was awarded a $3.5 million cooperative agreement over a five-year period from the CDC. To achieve the 80% goal, partners plan to conduct outreach and public education to increase awareness; work with healthcare providers to improve office systems; work with employers to allow time off from work for screening; address health plans’ policies in order to decrease financial barriers to screening; and provide a small number of free colonoscopies to New Hampshire residents age 50­–64 who are uninsured and at or below 250% of the federal poverty guidelines.
     
  • Breast cancer. When breast cancer is detected early (at the localized stage) the five-year survival rate is 98%.15 Despite the availability of screening through mammography and clinical breast exams, New Hampshire has seen a decline in the percent of women who reported that they had been screened in the last three years (89.8% of women in 2004 versus 86.1% in 2008, according to the 2008 NH BRFSS).30 By improving breast cancer screening rates, New Hampshire may see more early-stage diagnoses and significant reductions in mortality. To that end, the prevention and early detection work group has identified several objectives and will continue to support the New Hampshire Breast and Cervical Cancer Program (NH BCCP), which provides free clinical breast exams, mammograms, and diagnostic services for low-income, uninsured women age 18­–64.
     
  • Cervical cancer. Cervical cancer is one of the most treatable cancers when detected early through a Pap test. In addition, although there are more than 100 types of human papillomavirus (HPV), approximately 70% of cervical cancers are caused by HPV type 16 or 18, both of which now have vaccines. Because cervical cancer cells can be detected early with a Pap test or possibly prevented with a vaccine, cervical cancer is not one of the most frequently diagnosed cancers in New Hampshire. However, the rates for cervical cancer screening have either remained the same or declined across all income and education levels between 2002 and 2008.16,31 The prevention and early detection work group has prioritized the goal of increasing the number of New Hampshire women who report receiving a Pap test.
     
  • Prostate cancer. In 2009, there is no consensus among national organizations regarding prostate cancer screening. Both the ACS and the United States Preventive Services Task Force recommend that men engage in shared decision making with their physicians. To help New Hampshire men determine what is best for their needs, the NH CCC will continue to work closely with the NHPCC to encourage informed decision making between men and their healthcare providers.

No matter the type of cancer, it is critical that the unequal cancer burden among minorities and underserved populations be addressed. The NH CCC has identified target populations to help eliminate health disparities in the state.

Six objectives have been identified to guide prevention and early detection activities. Preliminary strategies for these objectives have also been identified, and will be clarified and expanded by the workgroup as it begins the implementation process.

Objectives | Current Activities | Accomplishments | NH Cancer Plan | Resources

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New Hampshire Comprehensive Cancer Collaboration, c/o Foundation for Healthy Communities
125 Airport Road Concord, NH 03301
phone (603) 415-4276 · fax (603) 225-4346 · email: info@nhcancerplan.org