Stand Against Cancer: Evaluating a Breast and Cervical Cancer Screening Program for Uninsured Patients

Background: Stand Against Cancer (SAC) is a long-running, community-based, organization-led program that addresses breast and cervical cancer disparities. Managed by Access Community Health Network (ACCESS), ongoing program evaluation reports on program performance over 5 years and public health implications. Objectives: To reduce disparities by making free cancer screening readily accessible to uninsured women and by connecting women to nurse case management to resolve abnormal screening results. Evaluation supports program management by assessing operations and outcomes. Methods: Health center staff completes patient applications that start the clock to achieve a resolution for all women who screen. All women with abnormal screens are referred to nurse case management and entered into a database for tracking. Program evaluation tracks the extent to which the predominantly minority women successfully reach resolution points, specifically the return of screening results and diagnostic resolution of abnormal results, including initiation of treatment. Results: A 5-year average of 10,400 women received SACsupported screening at ACCESS. Through nurse case management, 90% of patients with abnormal screening results received a diagnosis. Women increasingly return and screen in subsequent years, contributing to a lower rate of late-stage cancers. Uninsured patients receiving SAC screening made additional nonscreening visits. Evaluation determined that SAC participant outcomes approximate or exceed a comparable national cohort and that program outcomes demonstrate effectiveness, equity, and optimality. Conclusions: Annual SAC evaluation illustrates that removing access barriers and providing nurse case management support to patients with abnormal results produced nondisparate outcomes for uninsured women.