The elimination of financial and access barriers to screening improves screening rates. These barriers can be reduced, for example, through health insurance coverage, reduced cost sharing, and the availability of free screening at public clinics. In addition, certain organizational innovations are tied to improved screening performance, such as the implementation of systems to prompt providers to recommend screening, facilitate referrals, and remind patients and providers of the need for rescreening. Other opportunities to improve screening rates, particularly among underserved populations, include outreach and education, case management, and facilitation of referrals.

WHAT STEPS CAN BE TAKEN TO OVERCOME BARRIERS TO USING EFFECTIVE INTERVENTIONS AND TO IMPROVE WHAT WE KNOW ABOUT CANCER PREVENTION AND EARLY DETECTION?

The Board recommends that the following steps be taken to increase the rate of adoption, the reach, and the impacts of evidence-based cancer prevention and early detection interventions.

Recommendation 1: The U.S. Congress and state legislatures should enact and provide funding for enforcement of laws to substantially reduce and ultimately eliminate the adverse public health consequences of tobacco use and exposure.

Tobacco is the greatest contributor to deaths from cancer, and reduction in tobacco use offers the greatest opportunity to reduce the incidence, morbidity, and mortality of cancer. Specific actions that would be effective include the following:

  • Taxation is the single most effective method of reducing the demand for tobacco (IOM 2000a). States should set sufficiently high levels of excise taxation on tobacco products to discourage tobacco use, but levels should not be so high that they encourage significant tax avoidance activities.

  • States should allocate sufficient funds from the Tobacco Master Settlement Agreement1 and tobacco excise taxes to support comprehensive, state-based tobacco control efforts consistent with guidelines of the Centers for Disease Control and Prevention (CDC).

The CDC’s Office on Smoking and Health has identified nine essential

1  

The Master Settlement Agreement signed in 1998 transferred $246 billion from tobacco firms to states over 25 years.



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