compiling a list of best practices to be shared with agencies. Agencies can pay the costs incurred by employees participating in agency-authorized smoking cessation programs, including payment for nicotine replacement therapy when it is purchased as part of an agency’s smoking cessation program (www.opm.gov/ehs).

SUMMARY AND CONCLUSIONS

The federal government provides many opportunities to further cancer prevention and early detection by promulgating national goals and objectives, issuing clinical guidelines, disseminating information, carrying out monitoring and surveillance activities, facilitating statewide program planning and evaluation, and providing or paying for services.

Explicit national cancer-related goals and objectives have been set as part of the Healthy People 2010 initiative (US DHHS and Office of Disease Prevention and Health Promotion, 2000), and efforts are under way to chart the nation’s progress toward those goals. Federally sponsored evidence-based guidelines for clinical and community practice provide clinicians and public health providers with the information they need to achieve these goals. NCI is the lead federal agency in the dissemination of cancer-related information to clinicians, consumers, and the public health community through a number of channels including its telephone Cancer Information Service, its websites, and PDQ, a comprehensive cancer information database. Tracking the successes of these and other efforts in reaching cancer prevention and early detection goals often relies on federally sponsored surveys and surveillance systems that assess the prevalence of risk behaviors, levels of access to services, and health behaviors among the general and selected members of the U.S. population. Federal safety net providers including Community and Migrant Health Centers and Title X family planning clinics are key to closing the gap in service use and, ultimately, in reducing the unequal burden of cancer observed among poor and disadvantaged populations.

Although some federal programs are at the forefront of promoting effective cancer prevention and early detection interventions, there appears to be much room for improvement. In particular, policies are needed to improve coverage of evidence-based smoking cessation interventions within the Medicare and Medicaid programs. Such policies could greatly reduce the burden of cancer. In addition, the significant variations in the rates of use of screening services among beneficiaries served by the Medicare and VHA programs suggest that interventions are needed to improve rates of adherence to evidence-based guidelines.



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