Mass screening in low-income populations: The challenges of securing diagnostic and treatment services in a national cancer screening program

Funding for many mass screening programs for low-income and uninsured popul ations provides resources for screening tests, yet only rarely does it prov ide coverage for necessary follow-up diagnostic and treatment services. The National Breast and Cervical Cancer Early Detection Program (NBCCEDP), a f ederally funded initiative that provides cancer screening to low-income uni nsured and under insured women, covers some diagnostic follow-up tests and no treatment services. We conducted in-depth case studies of seven state pr ograms participating in the NBCCEDP to investigate the strategies and appro aches being used to secure diagnostic and treatment services. The results s uggest that the program relies on a patchwork of resources-at state and loc al levels-to provide diagnostic and treatment services. This includes a num ber of components of local safety nets, all of which are unstable and have uncertain futures. Public health disease-screening initiatives need to reco nsider the feasibility of continued reliance on case-by-case appeals to the local safety net for diagnostic follow-up and treatment services.