Inclusion of Evidence-Based Breast Cancer Control Recommendations and Guidelines in State Comprehensive Cancer Control Plans

Mehrnoosh Soori, MSc, PhD; Elizabeth A. Platz, ScD, MPH; Norma Kanarek, PhD, MPH


Prev Chronic Dis. 2020;17(10):e129 

In This Article

Abstract and Introduction


Introduction: Each US state, territory, and tribe/tribal organization is supported by the Centers for Disease Control and Prevention to develop and implement a comprehensive cancer control (CCC) plan. The objective of this study was to inform areas for improvement of those plans.

Methods: To show how CCC plans can be improved, we used the example of breast cancer, which has a long public health history and an established, broad spectrum of prevention and control activities. We evaluated the inclusion of evidence-based breast cancer prevention topics as provided by guidelines from the Centers for Disease Control and Prevention (CDC) and recommendations of the US Preventive Services Task Force (USPSTF) in each state's CCC plan. From January through March 2019, we downloaded CCC plans from each state and the District of Columbia and abstracted and quantified the content of plans for 1) discussion of data on breast cancer mortality, breast cancer incidence, uptake of mammography; 2) statement of objective to reduce the burden of breast cancer; and 3) review of CDC guidelines and USPSTF recommendations.

Results: The discussion of breast cancer–relevant topics and specification of objectives was incomplete. Of 51 plans, data on breast cancer mortality and incidence and uptake of mammography were reported in 53% (n = 27) to 76% (n = 39) of plans. CDC and USPSTF recommendations for breast cancer–specific interventions were discussed in only 6% (n = 3) to 37% (n = 19) of plans. Discussion of general cancer prevention topics relevant to breast cancer ranged from 10% (n = 5) to 61% (n = 31) of plans.

Conclusion: Our findings inform areas for quality improvement of state CCC plans and may contribute to other areas of public health planning.


Breast cancer is the most commonly diagnosed cancer and the most common cause of cancer-related death among women in the United States.[1] Breast cancer development is attributable to both nonmodifiable (eg, genetic predisposition) and modifiable (eg, reproductive, lifestyle) factors. Modifiable risk factors correlate with a spectrum of interventions available to address reductions in incidence or mortality. Maintaining a healthy weight, being physically active, eating an optimal diet (nutrition) with moderate to no alcohol intake, and breastfeeding may account for future declines in incidence by 29%.[2–4] Timely age-specific screening accounts for a 28% to 65% decrease in mortality.[5,6] High-risk status has often been determined from nonmodifiable factors (genetic factors and previous benign breast disease).[7,8] For women at high risk of breast cancer, chemoprevention and prophylactic surgery are available as primary prevention strategies.[2–4,9]

The Centers for Disease Control and Prevention's (CDC's) National Comprehensive Cancer Control Program (NCCCP) funds US states, territories, and tribes/tribal organizations to develop and implement plans to control cancer. CDC recommends state Comprehensive Cancer Control (CCC) plans include evidence-based recommendations and guidelines.[10] Accordingly, CDC recommends that state plans, which vary in their content and organization, present valid data from the state's cancer registry, describe the prevalence of cancer in diverse populations, and provide information on state population demographic characteristics. Plans should also present logically linked, clearly labeled specific, measurable, attainable, relevant and time-phased (SMART) objectives.[10]

Because breast cancer has a long history of extensive research supporting policy and program development and a broad spectrum of prevention and control activities, it provides a key test case for determining the quality of CCC plans, and more generally, for studying pitfalls and challenges of cancer prevention and control planning. We evaluated whether CCC plans discussed evidence-based breast cancer prevention topics as described in the most recent CDC guidelines and US Preventive Services Task Force (USPSTF) recommendations (Table 1). Our study objective was to inform areas for quality improvement of state CCC plans by using the example of breast cancer. This study may also inform state planning strategies (eg, SMART objectives) for additional areas of public health.