Cancer Prevention And Control: Screening, Quality Improvement And .
STATE OF DELAWARE DELAWARE HEALTH AND SOCIAL SERVICES Division of Management Services 1901 N. DuPont Highway New Castle, DE 19720 State of Delaware CANCER PREVENTION AND CONTROL: SCREENING, QUALITY IMPROVEMENT AND FACILITATION Request for Proposal HSS 23 006 For Division of Public Health December 5, 2022 - Deadline to Respond – January 25, 2023 1:00 PM (EDT) 6982(b) Version: 7/22/2022 1
STATE OF DELAWARE Department of Health and Social Services Division of Public Health REQUEST FOR PROPOSALS FOR PROFESSIONAL SERVICES FOR CANCER PREVENTION AND CONTROL: SCREENING, QUALITY IMPROVEMENT AND FACILITATION HSS 23 006 Contents: I. . Overview II. . Scope of Services III. . Required Information IV. . Professional Services RFP Administrative Information V. .Contract Terms and Conditions VI. . RFP Miscellaneous Information VII. . Attachments Appendix A - MINIMUM MANDATORY SUBMISSION REQUIREMENTS Appendix B - SCOPE OF WORK AND TECHNICAL REQUIREMENTS Appendix C - Sample Contract Boilerplate Appendix D - Sample HIPAA Business Associate Agreement Appendix E – Cover Page I. Overview The State of Delaware Department of Health and Social Services (DHSS), Division of Public Health (DPH) seeks professional services to provide Cancer Prevention and Control: Screening, Quality Improvement And Facilitation. This request for proposals (“RFP”) is issued pursuant to 29 Del. C. §§ 6981 and 6982. The proposed procurement schedule of events subject to the RFP is outlined below: Public Notice Date: December 5, 2022 Deadline for Receipt of Vendor Questions Date: December 19, 2022 Pre-Bid Meeting None Responses to Questions Posted by: Date: January 4, 2023 Deadline for Receipt of Proposals Date: January 25, 2023 at 1:00 PM EST Estimated Notification of Award Date: February 13, 2023 Estimated Project Begin Date Date: March 13, 2023 2
STATE OF DELAWARE Department of Health and Social Services Division of Public Health Each proposal must be accompanied by a transmittal letter which briefly summarizes the proposing firm’s interest in providing the required professional services. The transmittal letter must also clearly state and justify any exceptions to the requirements of the RFP which the applicant may have taken in presenting the proposal. (Applicant exceptions must also be recorded on Attachment 3). Furthermore, the transmittal letter must attest to the fact, at a minimum, that the Vendor shall not store or transfer non-public State of Delaware data outside of the United States. For technology related solicitations, Vendors may refer to the Delaware Department of Technology and Information identified terms and conditions included in this solicitation. The State of Delaware reserves the right to deny any and all exceptions taken to the RFP requirements. PRE-BID MEETING There will be no pre-bid meeting. Questions may be submitted no later than December 19, 2022. All inquiries must be submitted in the Q/A section of the project listing in the Bonfire Procurement Portal (https://dhss.bonfirehub.com). The Department’s response to questions will be posted, according to the procurement schedule, under the project listing in Bonfire and to the State of Delaware Bid Solicitation Directory Website: http://www.bids.delaware.gov/ by January 4, 2023. [balance of page is intentionally left blank] 3
STATE OF DELAWARE Department of Health and Social Services Division of Public Health II. Scope of Services A. Background Delaware Division of Public Health (DPH) is a nationally accredited State Public Health agency, recognized by the Public Health Accreditation Board (PHAB) for demonstrating commitment to quality improvement, performance management, accountability, transparency, and ability to address public health needs. DPH serves as the center of a comprehensive network of public health services, establishing public health priorities and evaluating the effectiveness of health initiatives. The mission of the Division of Public Health is to protect and enhance the health of the people of Delaware. The Division accomplishes its mission by: Working together with others; Addressing issues that affect the health of Delawareans; Keeping track of the State’s health; Promoting positive lifestyles; Responding to critical health issues and disasters; Promoting the availability of health services. Cancer Prevention and Control (CPC) in Delaware The Cancer Prevention and Control (CPC) Program is ideally positioned in the Health Promotion and Disease Prevention Section of DPH. In 2020, cardiovascular diseases and cancers accounted for 46 percent of all deaths in Delaware. 1 The CPC programs provides administrative staff support for the Delaware Cancer Consortium (DCC) and affiliated committees. The COVID-19 pandemic has unveiled the depth of health inequities in the U.S. Low-income communities and Delaware’s most vulnerable populations are experiencing a disproportionate burden of coronavirus in terms of both health outcomes and economic impact. Bidders of this RFP must propose equity focused recovery strategies to support the achievement of the following cancer prevention and control goals: eliminate preventable cancers, ensure all people get the right screening at the right time for the best outcome and support cancer survivors in a manner that allows them to live longer heathier lives. The Delaware Screening for Life (SFL) Program serves as the implementation vehicle for the National Breast and Cervical Cancer Early Detection Program (NBCCEDP). The SFL program was established in 1997 and offers dual eligibility determination and enrollment into the SFL Program and/or the Health Care Connection (HCC) program. SFL provides preventive cancer screening services to eligible clients. SFL utilizes a blend of state and federal funding to provide lung, colorectal, and prostate cancer screening services. SFL also provides care coordination to all SFL applicants to assist with mitigating barriers to screening. The Health Care Connection (HCC) connects uninsured eligible clients with a medical home and affordable healthcare services through the Medical Society of Delaware’s VIP 1 2020 Annual Report - Delaware Health and Social Services - State of Delaware 4
STATE OF DELAWARE Department of Health and Social Services Division of Public Health provider network. NBCCEDP services are specific to SFL’s breast and cervical (B&C) screening services. Since its initiation, SFL has provided clients with access to B&C cancer screenings as outlined in the NBCCEDP manual for billable and approved screening services federally funded through NBCCEDP. Additionally, SFL supplements B&C screening services that are not billable through federal funding with state funding to ensure all eligible SFL clients have equitable access to B&C preventive and diagnostic services. Delaware’s SFL program is housed within the Cancer Prevention and Control Bureau (CPCB) of the Health Promotion and Disease Prevention (HPDP) Section of the Delaware Division of Public Health. The SFL program collaborates closely with the Comprehensive Cancer Control Program (CCCP), the Delaware Cancer Registry (DCR) and the Delaware Cancer Consortium. These programs, although distinct in focus and outcomes, are considered part of the larger Delaware Cancer Program and represent individual components of the same team. In collaboration with SFL, DCR and CCCP, the Delaware Cancer Consortium (DCC) is a Governor-appointed consortium and focused on reducing cancer incidence and mortality through evidence-base programming in a multitude of areas. The DCC develops and oversees the implementation of the State Cancer Plan which encompasses cancer screening and early detection, tobacco cessation and physical activity awareness, environmental risk reduction (Healthy Homes), improvement in the quality of cancer screening and care, the Delaware Cancer Treatment Program, disparities elimination initiatives and services for people with cancer. Successful bidder(s) will be required to assist CPC in the implementation of all facets of the Next Five-Year Cancer Plan 2022-2026. State Plan goals and objectives can be found at the link provided in the previous statement. The Delaware Cancer Registry (DCR) collects information about new cancer cases, cancer treatment and cancer deaths. Registry data is used to monitor cancer trends, promote research to increase survival, guide program and policy planning, and respond to Delaware residents’ cancer concerns. The Comprehensive Cancer Program (CCP) implements and supports cancer coalition efforts that leverage resources to plan and implement evidence-based strategies to promote strategies focused on three primary priorities that directly align with Delaware’s 5-year State Cancer Control Plan: Priority 1: Primary Prevention Priority 2: Early Detection and Screening Priority 3: Health and Wellbeing of Cancer Survivors The Delaware Cancer Treatment Program (DCTP) was created and codified in 2004 to provide insurance coverage to uninsured and underinsured Delawareans for up to two full years of cancer treatment. DCTP serves as a payer of last resort and provides benefits to the extent that services are not covered by another payer. Information from the latest Cancer Incidence and Mortality Report: CANCER INCIDENCE: Delaware remains ranked 2nd highest nationally for cancer incidence and we have been in this position since 2002-2006. In 2013-2017, Delaware 5
STATE OF DELAWARE Department of Health and Social Services Division of Public Health had a significantly higher all-site cancer incidence rate compared to the U.S. (484.3 vs 435.0 per 100,000). 2 CANCER MORTALITY: Delaware ranked 15th highest nationally for cancer mortality (ranked 18th in 2012-2016). In 2013-2017, Delaware had a significantly higher all-site cancer mortality rate compared to the US (171.0 vs 158.3 per 100,000). Similar to incidence, mortality rates have trended downward in Delaware similar to the United States.2 CANCER SCREENING: Nationally, breast cancer screenings were 13% below historical averages, colon cancer screenings were 25% below, and cervical cancer screenings were 21% below in 2021. 3 In Delaware, we have seen similar declines in our Screening for Life data when comparing the periods of 2019-2020 to 2020-2021 with 38% decrease in breast cancer screenings, a 50% decrease in the number of cervical cancer screenings and 45% decrease in colorectal cancer screenings. Cancer screenings appear to be increasing but not at the numbers prior to the COVID-19 pandemic. Delays in cancer screening will require more cancer treatment and likely at later stage diagnoses. HEALTH DISPARITIES: Cultural and health disparities affect cancer rates. The top four cancers that affect Delaware the most are: lung, breast, prostate and colorectal. In 20132017, Non-Hispanic Black males (34.1 per 100,000) had a higher prostate cancer mortality rate compared to non-Hispanic White males (14.2 per 100,000). Although prostate mortality has decreased since 2003-2007, the disparity gap among Caucasian and African Americans has existed over time. 2 Non-Hispanic Black females (25.8 per 100,000 population) had a higher breast cancer mortality rate compared to Non-Hispanic White females (21.2 per 100,000 population). 4 HEALTH EQUITY: Provider cancer treatment claims, later stage cancer diagnosis and higher treatment costs as a result of the COVID-19 pandemic are a major concern for SFL programming under this RFP. There are pockets of individuals in our state who are disproportionately more affected by cancer. Heathy equity is when everyone has an equal opportunity to be as healthy as possible. In 2013-2017, Kent County had higher rates for all-site (all cancer types), lung and prostate cancer incidence compared to the other two counties. 5 Where people live and how they grow up influence not only attitudes but also access to care. The new five-year cancer plan includes cultural inclusivity and health disparity initiatives to address those inequities. Education, appropriate language, and better access to quality care are addressed across the board. DPH is committed to identifying health disparities and eliminating health inequities. All proposed strategies will promote efforts to achieve health equity through improvements in the social determinants of health. Successful bidders should support the identification of populations who tend to have cancer diagnoses in late stages. 2 2017.pdf 3 Cancer Screenings Are Still Lagging (epicresearch.org) 4 https://dhss.delaware.gov/dph/dpc/ca stats.html 5 Delaware Cancer Registry, October 2021 6
STATE OF DELAWARE Department of Health and Social Services Division of Public Health DATA MANAGEMENT: In June 2021, the CPC Bureau implemented a new contract vendor data collection system for the Screening for Life (SFL) program. This front-end data collection system is used in concert with the SFL database to support DPH’s response to statewide strategies aimed at mitigating the impact of chronic disease risk factors affiliated with cancer, other chronic conditions and COVID-19. Winning bidder(s) under this RFP will be required to report all activities and evidence-based interventions via the CPC’s Smartsheets system. This will align federal grant requirements, internal state operations with external clinical operations with SFL clients, comprehensive cancer program providers and health systems which will allow for ease of data collection, production of federal/state reports and establish a more robust centralized hub to systematically support decision making. CPC program operations under this RFP will require cross-collaborations between all three programs and successful applications will propose evidence, practice, or researchbased strategies that support expanding inclusivity and contribute to more racially equitable outcomes to ensure sustained interventions that achieve Delaware’s goals for Quadruple Aim - improving the health of Delawareans, enhancing the patient experience of care, reducing health care costs and improving provider satisfaction. This RFP program is DPH’s opportunity to strategize about how to work across sectors, address the long-term health and social needs of a community and remove structural barriers to health for socially vulnerable populations in Delaware. The CPC Bureau programs are: : 1. Breast & Cervical Cancer Early Detection and Prevention/Screening for Life 2. Comprehensive Cancer Control/ Cancer Registries 3. Clinical Cancer Consultation/Data Quality Improvement Please Note: The use of the terms “bidders,” “vendors,” “contractors,” and “applicants” are used interchangeably when describing the activities outlined in this RFP. Likewise, the use of “shall”, “must” and “will” are used interchangeably when describing applicant/bidder duties. B. Scope of Work/Bidders Requirements - Please refer to Appendix B for additional details/requirements for the Scope of Services. III. Required Information The following information shall be provided in each proposal in the order listed below. Failure to respond to any request for information within this proposal may result in rejection of the proposal at the sole discretion of the State. A. Minimum Requirements 1. Provide Delaware license(s) and/or certification(s) necessary to perform services as identified in the scope of work. Prior to the execution of an award document, the successful Vendor shall either furnish the Agency with proof of State of Delaware Business Licensure or initiate the process of application where required. 7
STATE OF DELAWARE Department of Health and Social Services Division of Public Health 2. Vendor shall provide responses to the requirements defined in the Request for Proposal (RFP) Appendix B Scope of Work and shall clearly describe capabilities as presented in the General Evaluation Requirements below. 3. Complete all appropriate attachments and forms as identified within the RFP. 4. Proof of insurance and amount of insurance shall be furnished to the Agency prior to the start of the contract period and shall be no less than as identified in the bid solicitation, Section V, Item G, subsection 8 (insurance). B. General Evaluation Requirements 1. 2. 3. 4. 5. 6. Experience and Reputation Expertise (for this particular project) Capacity to meet requirements (size, financial condition, etc.) Location (geographical) Demonstrated ability Familiarity with this type of work and its requirements IV. Professional Services RFP Administrative Information A. RFP Issuance 1. Public Notice Public notice has been provided in accordance with 29 Del. C. § 6981. 2. Obtaining Copies of the RFP This RFP is available in electronic form through the State of Delaware Procurement website at www.bids.delaware.gov . Paper copies of this RFP will not be available. 3. Assistance to Vendors with a Disability Vendors with a disability may receive accommodation regarding the means of communicating this RFP or participating in the procurement process. For more information, contact the Designated Contact no later than ten days prior to the deadline for receipt of proposals. 4. RFP Designated Contact All requests, questions, or other communications about this RFP shall be made through Bonfire at https://dhss.bonfirehub.com. Communications made to other State of Delaware personnel or attempting to ask questions by phone or in person will not be allowed or recognized as valid and may disqualify the vendor. Vendors should rely only on information posted at https://dhss.bonfirehub.com. The RFP designated contact. Agency Contact: Maxwell Amoako Bureau Chief, Cancer Prevention and Control Health Promotion and Disease Prevention Thomas Collins Building, 2nd floor 8
STATE OF DELAWARE Department of Health and Social Services Division of Public Health 540 S. DuPont Highway, Ste. 11 Dover, DE 19901 Maxwell.A.Amoako@delaware.gov Contracts, Management and Procurement Contact: Eddie Mui Purchasing Services Administrator DHSS DMS dmsprocure@delaware.gov To ensure that written requests are received and answered in a timely manner via Bonfire at https://dhss.bonfirehub.com. 5. Consultants and Legal Counsel The State of Delaware may retain consultants or legal counsel to assist in the review and evaluation of this RFP and the vendors’ responses. Bidders shall not contact the State’s consultant or legal counsel on any matter related to the RFP. 6. Contact with State Employees Direct contact with State of Delaware employees other than the State of Delaware Designated Contact regarding this RFP is expressly prohibited without prior consent. Vendors directly contacting State of Delaware employees risk elimination of their proposal from further consideration. Exceptions exist only for organizations currently doing business in the State who require contact in the normal course of doing that business. 7. Organizations Ineligible to Bid Any individual, business, organization, corporation, consortium, partnership, joint venture, or any other entity including subcontractors currently debarred or suspended is ineligible to bid. Any entity ineligible to conduct business in the State of Delaware for any reason is ineligible to respond to the RFP. 8. Exclusions The Proposal Evaluation Team reserves the right to refuse to consider any proposal from a vendor who: a. Has been convicted for commission of a criminal offense as an incident to obtaining or attempting to obtain a public or private contract or subcontract, or in the performance of the contract or subcontract: b. Has been convicted under State or Federal statutes of embezzlement, theft, forgery, bribery, falsification, or destruction of records, receiving stolen property, or other offense indicating a lack of business integrity or business honesty that currently and seriously affects responsibility as a State contractor: c. Has been convicted or has had a civil judgment entered for a violation under State or Federal antitrust statutes: d. Has violated contract provisions such as; 1) Known failure without good cause to perform in accordance with the specifications or within the time limit provided in the contract; or 2) Failure to perform or unsatisfactory performance in accordance with terms of one or more contracts; e. Has violated ethical standards set out in law or regulation; and 9
STATE OF DELAWARE Department of Health and Social Services Division of Public Health f. Any other cause listed in regulations of the State of Delaware determined to be serious and compelling as to affect responsibility as a State contractor, including suspension or debarment by another governmental entity for a cause listed in the regulations. B. RFP Submissions 1. Acknowledgement of Understanding of Terms By submitting a bid, each vendor shall be deemed to acknowledge that it has carefully read all sections of this RFP, including all forms, schedules and exhibits hereto, and has fully informed itself as to all existing conditions and limitations. 2. ALL PROPOSALS MUST BE SUBMITTED ONLINE ON THE DEPARTMENT OF HEALTH AND SOCIAL SERVICES’ Eprocurement portal, which is currently found at https://dhss.bonfirehub.com/. Responses submitted by hard copy, mail, facsimile, or e-mail will not be accepted. 3. Proposals To be considered, all proposals must be submitted online through Bonfire at https://dhss.bonfirehub.com/ and respond to the items outlined in this RFP. The State reserves the right to reject any non-responsive or non-conforming proposals. All proposals must be submitted prior to 1:00 PM (EDT) on January 25, 2023. PROPOSAL REQUIREMENTS a. Proposals must be received before the Proposal Due Date and Time, as identified in the Procurement Schedule for this RFP. Responses received after the Proposal Due Date and Time will not be accepted. b. Upload your submission at: https://dhss.bonfirehub.com . Important Notes: Logging in and/or uploading the file(s) does not mean the response is submitted. Users must successfully upload all the file(s) and MUST click the submit button before the proposal due date and time. Users will receive an email confirmation receipt with a unique confirmation number once the submission has been finalized. This will confirm that the proposal has been submitted successfully. Each submitted item of Requested Information will only become visible to DHSS after the proposal due date and time. If the file is mandatory, you will not be able to complete your submission until the requirement is met. Uploading large documents may take significant time depending on the size of the file(s) and your Internet connection speed. The maximum upload file size is 1000 MB. Minimum system requirements: Internet Explorer 11, Microsoft Edge, Google Chrome, or Mozilla Firefox. Java Script must be enabled. 10
STATE OF DELAWARE Department of Health and Social Services Division of Public Health Notarizations are no longer required. Need Help? Please contact Bonfire directly at Support@GoBonfire.com or 1(800)6548010 ext. 2 for technical questions or issues related to your submission. You can also visit their help forum at https://bonfirehub.zendesk.com/hc. Any proposal submitted after the Deadline for Receipt of Proposals date will not be accepted. The contents of any proposal shall not be disclosed as to be made available to competing entities during the negotiation process. Upon receipt of vendor proposals, each vendor shall be presumed to be thoroughly familiar with all specifications and requirements of this RFP. The failure or omission to examine any form, instrument or document shall in no way relieve vendors from any obligation in respect to this RFP. 4. Proposal Modifications Any changes, amendments or modifications to a proposal must be made in writing, submitted in the same manner as the original response and conspicuously labeled as a change, amendment, or modification to a previously submitted proposal. Changes, amendments, or modifications to proposals shall not be accepted or considered after the hour and date specified as the deadline for submission of proposals. 5. Proposal Costs and Expenses The State of Delaware will not pay any costs incurred by any Vendor associated with any aspect of responding to this solicitation, including proposal preparation, printing or delivery, attendance at vendor’s conference, system demonstrations or negotiation process. 6. Proposal Expiration Date Prices quoted in the proposal shall remain fixed and binding on the bidder at least through January 24, 2024. The State of Delaware reserves the right to ask for an extension of time if needed. 7. Late Proposals Proposals submitted after the specified date and time will not be accepted by the Bonfire Portal. Evaluation of the proposals is expected to begin shortly after the proposal due date. To document compliance with the deadline, the proposal will be date and time stamped upon receipt by Bonfire. 8. Proposal Opening The State of Delaware will receive proposals via Bonfire until the date and time shown in this RFP. Proposals will be opened in the presence of State of Delaware personnel. There will be no public opening of proposals, but a public log will be kept of the names of all vendor organizations that submitted proposals. The contents of any proposal shall not be disclosed in accordance with Executive Order # 31, Delaware Code, Chapter 100. 11
STATE OF DELAWARE Department of Health and Social Services Division of Public Health 9. Non-Conforming Proposals Non-conforming proposals will not be considered. Non-conforming proposals are defined as those that do not meet the requirements of this RFP. The determination of whether an RFP requirement is substantive, or a mere formality shall reside solely within the State of Delaware. 10. Concise Proposals The State of Delaware discourages overly lengthy and costly proposals. It is the desire that proposals be prepared in a straightforward and concise manner. Unnecessarily elaborate brochures or other promotional materials beyond those sufficient to present a complete and effective proposal are not desired. The State of Delaware’s interest is in the quality and responsiveness of the proposal. 11. Realistic Proposals It is the expectation of the State of Delaware that vendors can fully satisfy the obligations of the proposal in the manner and timeframe defined within the proposal. Proposals must be realistic and must represent the best estimate of time, materials and other costs including the impact of inflation and any economic or other factors that are reasonably predictable. The State of Delaware shall bear no responsibility or increase obligation for a vendor’s failure to accurately estimate the costs or resources required to meet the obligations defined in the proposal. 12. Confidentiality of Documents The State of Delaware and its constituent agencies are required to comply with the State of Delaware Freedom of Information Act, 29 Del. C. § 10001, et seq. (“FOIA”). FOIA requires that the State of Delaware’s records are public records (unless otherwise declared by FOIA or other law to be exempt from disclosure) and are subject to inspection and copying by any person upon a written request. All proposals are subject to FOIA’s public disclosure obligations. The State of Delaware wishes to create a business-friendly environment and procurement process. As such, the State respects the vendor community’s desire to protect its intellectual property, trade secrets, and confidential business information (collectively referred to herein as “confidential business information”). Proposals must contain sufficient information to be evaluated. If a vendor feels that they cannot submit their proposal without including confidential business information, they must adhere to the following procedure, or their proposal may be deemed unresponsive, may not be recommended for selection, and any applicable protection for the vendor’s confidential business information may be lost. In order to allow the State to assess its ability to protect a vendor’s confidential business information, vendors will be permitted to designate appropriate portions of their proposal as confidential business information. Vendor(s) may submit portions of a proposal considered to be confidential business information in a separate, sealed files labeled “Confidential Business Information” and include the specific RFP number. The envelope must contain a letter from the vendor’s legal counsel describing the documents in the file, representing in good faith that the 12
STATE OF DELAWARE Department of Health and Social Services Division of Public Health information in each document is not “public record” as defined by 29 Del. C. § 10002, and briefly stating the reasons that each document meets the said definitions. Upon receipt of a proposal accompanied by such a separate, files, the State of Delaware will open the files to determine whether the procedure described above has been followed. A vendor’s allegation as to its confidential business information shall not be binding on t
cancer screenings as outlined in the NBCCEDP manual for billable and approved screening services federally funded through NBCCEDP. Additionally, SFL supplements B&C screening services that are not billable through federal funding with state funding to ensure all eligible SFL clients have equitable access to B&C preventive and diagnostic services.
As the Chair and Co-Chair of the Kansas Cancer Partnership (KCP), we are pleased to provide . you with the 2017-2021 Kansas Cancer Prevention and Control Plan. This plan is the result of . Breast Biopsies Breast Cancer Cervical Cancer Colorectal Cancer Lung Cancer Prostate Cancer. Post-Diagnosis & Quality of Life throughout the Cancer Journey.
Breast Cancer Screening in Normal and High-risk Populations 186 43. Ovarian Cancer Screening in Normal and High-risk Populations 190 44. Osteoporosis Screening 194 SECTION 8 Gynaecological Cancer 201 45. Cervical Cancer 201 46. Endometrial Cancer 206 47. Ovarian Cancer 212 48. Vulvar Cancer
Lung cancer screening: the cost of inaction 2 Table of contents Executive summary 3 1 Introduction 7 2 Lung cancer: a public health priority 9 3 Earlier detection: the key to reducing the burden of lung cancer 12 4 LDCT screening for lung cancer: the next big opportunity in cancer detection 18 5 An investment in health system sustainability 21 6 Ensuring successful implementation of lung cancer
Ovarian cancer is the seventh most common cancer among women. There are three types of ovarian cancer: epithelial ovarian cancer, germ cell cancer, and stromal cell cancer. Equally rare, stromal cell cancer starts in the cells that produce female hormones and hold the ovarian tissues together. Familial breast-ovarian cancer
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Conclusions: The study revealed utilization of cervical cancer screening service was low among HIV positive women. Educational status, duration of HIV diagnosis, partner support, knowledge status about risk factor, CD4 count and attitude towards cervical cancer and its screening were associated with cervical cancer screening utilization.
Working together to lessen the impact of skin cancer in NSW 1 Contents Foreword from the Minister for Health 2 Introduction from the Chief Cancer Officer, NSW 3.13 Skin cancer in New South Wales 5 The incidence and impact of skin cancer 5 The Cancer Institute NSW 7 The NSW Skin Cancer Prevention Strategy 2012-2015 8
