SDG CERVICAL CANCER

Empowering Societies to be Free of Cervical Cancer Project by the Breast and Cervical Cancer Screening Program (BCCSP)

Section 1: Introduction

The Breast and Cervical Cancer Screening Program (BCCSP) is an initiative of the Doctors Community Hospital in Prince George County, Maryland. The program began as a center offering free breast cancer education and screening to low-income women (age 40 or older) residing in Prince George County. However, with the rising cases of cervical cancer across the state, the BCCSP decided to expand its scope to cover cervical cancer and also move beyond screening and education to offer subsidized treatment and support to patients. The BCCSP is funded by the Maryland Department of Health and Mental Hygiene. The program proposes to implement a project dubbed Empowering Societies to be Free of Cervical Cancer between January 2024 and December 2025. The programs clinical team comprises of seven directors of medicine (MD), two certified registered nurse practitioners (CRNP), and one physician assistant (PA). On the support side, the program has a nurse navigator, a chaplain, a team of oncology social workers, a medical acupuncturist, an occupational therapist, a licensed dietician, and a financial counselor.

Section 2: Sustainable Development Goal

Sustainable Development Goal (SDG) 3 focuses on promoting healthy lives and well-being for people of all ages as a channel for sustainable development (United Nations, 2023). Target 7 of SDG 3 is to ensure that reproductive healthcare services, including education and information, are universally accessible and that reproductive health is integrated into national programs and strategies by the end of 2030 (United Nations, 2023). Ultimately, this will reduce cases of premature mortality resulting from non-communicable diseases globally (United Nations, 2023). Cervical cancer affects reproductive health in thousands of women, particularly in cases where practitioners recommend surgery to remove a womans womb (radical hysterectomy). Even in cases where surgery is not necessary, studies have shown that 46 percent of cervical cancer survivors are unable to conceive despite receiving reproductive counseling due to damages to the reproductive organs resulting from radiotherapy (Shah et al., 2019).

Data from the World Health Organization (WHO) shows that 604,000 new cases of cervical cancer and 342,000 deaths were reported globally in 2020 alone, making it the fourth most common cancer among women (WHO, 2022). In the United States, an estimated 295,000 women had cervical cancer in 2019, and 5,000 women die from cervical cancer every year (National Cancer Institute, 2022). The National Cancer Institute indicates that new cases are diagnosed at a rate of 7.8 per 100,000 women annually (National Cancer Institute, 2022). While it is less common than other cancers such as breast cancer, the BCCSP chooses to focus its efforts on cervical cancer because is not only treatable, but more preventable due to the availability of vaccines.

Cervical cancer is caused by the human papilloma virus (HPV), which is spread through sexual activity (WHO, 2022). It is estimated that all sexually-active women get HPV, although one can reduce their chances of developing cervical cancer through vaccination (WHO, 2022). African-American women disproportionately bear a higher burden of cervical cancer in the US and are less likely to be vaccinated (National Cancer Institute, 2022). For this reason, the proposed project targets African-American women residing in Prince George County. It adopts a radical approach that incorporates preventive, curative, and palliative strategies to improve the quality of life, reduce incidence, and minimize deaths resulting from cervical cancer.

On the preventive front, the program will offer free screening to uninsured women, sensitize communities on the importance of screening and vaccination, organize telehealth and in-person campaigns to educate communities on the benefits of vaccination and where to get vaccines, and increase access to thermal ablation for cervical pre-cancer treatment. Curative strategies will include offering free radiotherapy, chemotherapy, and hormone therapy for invasive cervical cancer cases. Palliative strategies will include free counseling and fertility treatment for survivors wishing to get pregnant, free financial counseling services, and subsidized genetic counseling for at-risk family members. Financial counseling is geared at helping patients manage their expenses and finances, and make decisions that enhance their financial health. Genetic counseling focuses on helping family members with a family history of cancer understand the risks they face and strategies for managing or lowering their risk of cancer.

Section 3: Logical Model

Overarching Goal: to create a world free of cervical cancer

Logical Model Date: 7th April, 2023

Inputs

Outputs

Outcomes -- Impact

Activities

Short

Medium

Long

Grants, community leaders, licenses

Grants

Staff (human resources), grants

University of Marylands Marlene and Stewart Comprehensive Cancer Center

Radiation equipment

Prince George County Health Centre

Financial counselors

Oncology social workers

Organize quarterly medical camps where women can access free HPV screening and pap smear tests

Offer non-coercive rewards such as coupons to encourage women to undergo screening as a means to curb cultural practices and beliefs that discourage screening

Conduct Monthly sensitization campaigns to educate women on cervical cancer and the importance of regular screening and vaccination

Develop tele-health mobile applications through which women can obtain virtual advice from oncologists and social workers on when and where to get free screening tests

Partner with the University of Maryland Cancer Center, where women with special conditions such as epilepsy, could be referred upon screening to access subsidized pre-cancer treatment through thermal ablation

Offer free radiotherapy, chemotherapy, and free hormone therapy for invasive cervical cancer cases.

Partner with fertility clinics from which cervical cancer survivors wishing to get pregnant could access free reproductive counseling

Offer free financial and genetic counseling to program participants and their family members

Uninsured women benefit from free HPV screening and pap smear tests

Women are more knowledgeable about cervical cancer and where to get free tests and vaccines

Women with special conditions get access to less invasive therapies

Uninsured women get access to quality cervical cancer treatment

Women gain access to reproductive counselling that would otherwise be unaffordable

Women from low-income backgrounds and their families gain access to free genetic and financial counseling

Increased rates of regular HPV screening among uninsured African-American women

Improved attitudes towards vaccination and screening

Increased access to less-invasive pre-cancer treatments for women with special health conditions

Uninsured women living with cervical cancer lead satisfying lives

Over 50% of cervical cancer survivors get pregnant after undergoing counseling

Women are able to make informed financial decisions and families understand how to minimize their risk of cervical cancer

Increase in cases of HPV infections that are detected and treated early before developing into cancer

Increase in the number of women presenting their children for HPV vaccination

Reduced deaths related to cervical cancer among women with special health conditions

Reduced deaths related to cervical cancer among women with special health conditions

Improved reproductive health for cervical cancer survivors

Cancer patients and their families lead financially stable lives with low risk of getting cervical cancer

Assumptions

The program will acquire the funding it...…final summative evaluation will be conducted at the end of the second year to determine whether the program has realized its goals and whether or not it needs to continue for another two years.

Section 6: Consequences

Anticipating the unintended consequences of a project is a best practice for success. It ensures the project team puts in place systems to mitigate challenges that may come up. One of the unintended consequences is a conflict between religion/cultural beliefs and what the program advocates for. For instance, studies have shown that religion and cultural beliefs may both hinder women from taking screening tests because of the provision requiring women to cover their bodies. Obikunle and Ade-Oshifigun (2022), for instance, found that a sample of African-American women may shun cancer screening for fear of exposing sensitive parts of their bodies, which is against their cultural and religious beliefs. This could affect the communitys response to the program and its interventions. To address this, the program will engage some of its African-American staff in sensitization campaigns and to serve as role models for women who may opt out of the project due to cultural or religious beliefs. These belies are likely to be less influential if women in the community identify with members of the program team.

Another unintended consequence is that community members may develop a culture of dependency as a result of the free and subsidized services available in the program. In this regard, beneficiaries may be unwilling to sacrifice their resources when required to, and may expect the program to cover all treatment costs for them. The end-result is that if in future the team decides to charge a subsidized fee for services offered, the project could face resistance from the community.

Section 7: Conclusion

In conclusion, cancer continues to be a major source of death globally. This project focuses on cervical cancer, the fourth most common form of cancer among women. According to the World Health Organization (WHO), 604,000 new cases of cervical cancer and 342,000 deaths were reported globally in 2020 alone. In the United States, an estimated 295,000 women had cervical cancer in 2019, and an estimated 5,000 women die from cervical cancer every year. Fortunately, cervical cancer is preventable and women can reduce their chances of getting it through vaccination. At the same time, like other cancers, cervical cancer is largely treatable if detected early. Rates of vaccination and regular screening among women from minority groups remain low. This calls for the concerted efforts of all relevant stakeholders, including government officials, local communities, health workers, and non-governmental organizations to sensitize more women on the importance of regular screening and the benefits of vaccination.

The proposed project pursues the overarching goal of creating a world free of cervical cancer. The long-term outcome of the project is to reduce deaths resulting from cervical cancer in Prince George County, Maryland. The middle-term outcome is increased access to screening and testing, improved attitudes towards screening and vaccination, increased access to free cervical cancer treatment, and improved financial management for patients and their families, leading to improved quality of life. In the short-erm, the project seeks to ensure that more women can access free screening, treatment, and support in the form of financial as well as genetic counseling for family members. Through its efforts, the…