The Cancer Plan
Enhance Early Detection for Priority Cancers
When cancer is found early, it’s often easier to treat—and survival rates are much higher. That’s why early detection is one of the most powerful tools we have to save lives in Georgia.
This section of the Georgia Cancer Plan focuses on increasing access to recommended screenings for cancers that can be detected early, especially in communities that face the greatest barriers to care.
Background
Finding cancer early improves the opportunity for excellent outcomes, including potential cures and long-term survival. Based on current evidence, screening for breast, cervical, lung, and colorectal cancers in appropriate populations by age and/or genetic risk can save lives. Screening for early-stage cancer can save lives because treatments are generally more effective at earlier than later stages of disease. Table 1 describes rates of early-stage disease for the five target cancers.
Over the previous five years, statewide efforts have focused on the use of recommended screening tests and procedures (US Preventive Services Task Force, National Cancer Institute, NCI, and American Cancer Society) to help in the early detection of at least some of the target cancers. The Georgia Department of Public Health, through its cancer programs and local partners, including the Regional Cancer Coalitions, provides support for low-income, uninsured, and underserved individuals to access timely breast, cervical, and colorectal cancer screening, diagnostic services, and treatment through the Breast and Cervical Cancer Screening Program and the Georgia Cancer State Aid Program.
Notwithstanding these efforts, differences in screening rates continue to be challenging throughout the state, with minority, low-income, and rural populations reporting fewer screenings. Because of this and the challenge of the high burden of prostate cancer in the state, the Consortium has adopted the National Academy of Science and Medicine’s (NASM) roundtable model and approach to proactively tackle the issue of screening and hand-offs for these cancers. The roundtable model creates sustained partnerships across diverse sectors and communities to tackle long-standing and emerging cancer issues.
An estimated 17,880 cancer deaths in Georgia can be prevented through early detection and screening. According to the 2020-2021 Georgia Behavioral Risk Factor Surveillance System, the self-reported cancer screening rates are:
- 79% of women ages 50 to 74 years reported having had a mammogram in the last two years;
- 77% of women ages 21 to 65 years reported having a Pap test within the past three years;
- 68% of adults ages 50 to 75 years reported having had a fecal occult blood test (FOBT) in the last year, or sigmoidoscopy in the last five years, and/or colonoscopy in the last ten years, and
- Three out of four Georgia men ages 40 and older discussed the advantages of PSA screening with a healthcare Of those men for whom a PSA was recommended by a health professional, about 90% received a PSA, and 70% had done so within the past year.
While the effort will focus on these target cancers, the changing epidemiology of cancer in the state also warrants that surveillance supports and informs approaches to detect, as early as possible, other burdensome cancers for which there are currently no screening guidelines (e.g., pancreatic and pediatric brain cancers).
Objectives
Objective 1A
Increase screening rates through the use of evidence-based approaches for the early detection of breast, cervical, colorectal, lung, and prostate cancers in Georgians, with a focus on populations most adversely affected and burdened by these conditions.
Objective 1B
Increase early detection in high- risk persons who fall outside of current criteria and recommendations for screening for breast, cervical, colorectal, lung, and prostate cancers.
Objective 2
Reduce disparities in screening rates among people groups and target populations through interventions to address health inequities.
Objective 3
Increase early detection rates for non-screenable and potentially aggressive cancers for which screening is not currently recommended (e.g., pancreatic, head and neck, and childhood leukemias and lymphomas) and encourage ongoing research in this area.
Strategies
Strategy | Strategic Actions | Target Populations | Key Collaborators |
| Ensure Quality Data and Continuous Learning | Facilitate the creation of an inventory of statewide early detection and screening efforts, including those focused on education and awareness. Ensure ongoing and appropriate screening surveillance and assessments with special emphasis on Uniform Data System (UDS) reports to monitor progress to reduce inequities and disparities in early detection and screening. Promote research and the use of epidemiological data for systems and providers to know, track, and monitor screening rates and disparities. Promote research to develop an “Equity Index” to compile and encourage reporting of screening rates by safety net providers. | Georgia-based researchers and academicians Public Health Health Systems |
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| Broaden Awareness and Engagement | Collaborations on awareness and communication campaigns to improve Georgians’ knowledge and understanding of the importance of family history, timing, and screening guidelines in early detection, particularly for those at high risk for these cancers. | Georgia residents and communities, particularly those most adversely impacted by low access to screening |
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| Improve Provider Education, Clinical Training and Practice | Work with providers and health systems to conduct educational sessions and trainings that promote evidence-based screening guidelines in identified communities of interest. To support early detection, promote appropriate use of navigation and referral systems to ensure quality and effective follow-up, especially in low- income, rural, and underserved communities. Sustain and further build out the use of roundtable approaches to engage key stakeholders in collaborating and partnering for action. Facilitate the establishment of two additional roundtables – HPV-related cancers and breast cancer. Facilitate targeted health system initiatives to address low screening rates in Georgia, particularly in disparate populations and communities that are/have been challenged by inequities. Promote the use of navigators and community health workers in targeted populations and communities of interest to increase access to appropriate screening. | Clinical and non-clinical providers of services, including primary care physicians, nurses, navigators, and community health workers Health Systems and Health Plans |
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| Facilitate Policy Action and Advocacy | Pursue and support direct and in-kind funding and policy advocacy for cancer screening in low-income and uninsured individuals and communities. | Legislators and policymakers |
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Cancer specific screening roundtables will share responsibility and support the Workgroup in the effort to achieve the set-out objectives.
Cancer-Specific Strategic Actions
Cervical Cancer
- Facilitate access to high-quality cervical cancer screening for all women, regardless of income, race, insurance, or employment status.
- Sustain existing community-based cervical cancer screening programs, including the Breast and Cervical Cancer Program (BCCP), that screen large populations of women from uninsured and underinsured
Breast Cancer
- Facilitate access to high-quality breast cancer screening as well as genetic screening, counseling, and preventive clinical services related to Hereditary Breast and Ovarian Cancer syndrome (HBOC) for all women, regardless of income, race, insurance, or employment status.
- Sustain existing community-based breast cancer screening programs that screen at least 60 percent of women from racial/ethnic minority groups.
- Promote genetic screening to all low-income, high-risk, and rarely screened women 18 years and
- Seek Medicaid and State Health Benefit Plan reimbursement for appropriate genetic screening and counseling, as well as preventive surgeries such as bilateral mastectomies and/or oophorectomy/ salpingectomy for high-risk women.
Colorectal Cancer
- Facilitate access to high-quality colorectal cancer
- Increase screening and appropriate genetic testing for colorectal cancer in adults at high risk and/or with a family history of colorectal cancer regardless of insurance status and increase screening among them.
- Conduct provider education sessions and trainings to promote accuracy of stool-based testing, screening methods, and options.
- Develop and test communications messages aimed at groups with low screening rates and other high-risk
- Conduct community education initiatives to inform communities about changes to the recommended screening age change of 45 years.
Lung Cancer
- Increase the number of eligible Georgia residents screened for lung cancer regardless of income, race, insurance, or employment status.
- Encourage high-quality screening that follows existing US Prevention Task Force and/or NCCN 2 category
- Improve access to safe and responsible screening by increasing the utilization of quality lung cancer screening programs throughout Georgia.
- Research to find the best methods for providers to know their screening
Prostate Cancer
- Increase the use of population-specific screening approaches that reduce morbidity and mortality from prostate cancer and its treatment in Georgia.
- Promote the use of informed decision-making to develop appropriate screening
- Encourage Georgia-based epidemiologic/disparity research on prostate cancer screening, risk factor classification, and effectiveness.
Currently Non-screenable Cancers
- Support the engagement of key stakeholders and clinical providers in improving knowledge and practice that result in earlier detection of non-screenable cancers.
- Support research to find effective screening for other high-impact cancers like pancreatic, kidney, skin, and brain cancers.
Measures
5 Year Success Measure | Baseline Values | Target Values |
| The proportion of women who receive cervical cancer screenings based on current USPSTF guidelines | 77% | 83% |
| Race, geography, income, and insurance coverage disparities in cervical cancer screening | 10% reduction in gap (relative) | |
| The proportion of women who receive breast cancer screenings based on current USPSTF guidelines | 79% | 82% |
| Race, geography, income, and insurance coverage disparities in breast cancer screening | 10% reduction in gap (relative) | |
| The proportion of adults over 45 years who have received colorectal cancer screening* | 75% | 80% in every community where intervention and measurements occur, including FQHCs; 75% of Behavioral Risk Factor Surveillance System (BRFSS) reporting |
| Race, geography, income, and insurance coverage disparities in colorectal cancer screening | 10% reduction in gap (relative) | |
| Level of reported informed decision-making about prostate screening | 66% of Georgia men 40+ did not discuss the advantages or disadvantages of PSA. For men who spoke with providers, 44% only discussed the advantages of PSA, and 37% discussed the disadvantages of PSA testing. | At least 70% of men report having talked with their healthcare provider about the advantages and disadvantages of PSA testing |
| Amount of Georgia-based prostate cancer screening research | Complete at least two prostate cancer research projects by 2024 | |
| Early-stage rates in target cancers (stratified by race and gender) | Breast: Overall increase in early stage by 0.3%. Cervical: Overall decrease in early stage by 0.9%. Colorectal: Overall decrease in early stage by 3.4%. Lung: Overall increase by 2.2%. Prostate: Overall decrease by 3.8%; | 5% increase over the period for the five target cancers |
| Early detection rates for other cancers – skin cancer, pediatric cancers, etc. | 10% increase in the rate of nontarget cancers that are detected |