Every Woman Counts (EWC) assists California women in accessing crucial breast and cervical cancer screening and diagnostic services through a network of participating health-care providers throughout the state. Services for eligible women include:
Office visits and consultations
Human Papillomavirus (HPV) testing
Diagnostic testing for abnormal results
Referrals to treatment
The mission of EWC is to save lives by preventing and reducing the devastating effects of cancer for Californians through early detection, diagnosis, and treatment. EWC works with women who are underserved, including women who are uninsured or underinsured, geographically and culturally isolated, and women who are members of a racial, ethnic, or cultural minority group.
Eligible women must:
Be 21 years of age and older to qualify for cervical cancer screening and diagnostic services.
Be 40 years of age and older to qualify for breast cancer screening and diagnostic services.
Be any age with breast cancer symptoms for breast cancer diagnostic services.
Have a physical California address or, if homeless, a location where the woman can be contacted and/or receive mail.
Not have any private or public insurance coverage or, if insured, must not be able to afford deductibles, copays, or share of cost.
EWC is one of the largest breast cancer detection programs in the nation. It provides services through a statewide network of approximately 900 Medi-Cal primary care providers and more than 2,000 referral providers.
In 2014-2015, EWC sponsored approximately 160,929 screening and/or diagnostic mammograms, 27,580 ultrasounds, and 148,847 other breast services.
In 2014-2015, EWC sponsored approximately 160,929 screening and/or diagnostic mammograms, 27,580 ultrasounds, and 148,847 other related services such as breast health consultations, CBEs, and breast biopsies. EWC providers diagnosed 1,445 women with breast cancer in 2013 (the most recent data available); most diagnoses (1,204) were of invasive breast cancer. Diagnoses through EWC accounted for 4.7% of all invasive breast cancers diagnosed in California that year.1
EWC is administered through the California Department of Health and Human Services Cancer Detection and Treatment Branch. It is funded in part by the National Breast and Cervical Cancer Early Detection Program (NBCCEDP-described below) and the State of California, including California's Breast Cancer Control Account (BCCA), Proposition 99, and the General Fund.
Breast and Cervical Cancer Treatment Program (BCCTP)
Low-income, eligible women who are diagnosed with breast cancer may be referred to the Breast and Cervical Cancer Treatment Program (BCCTP) for treatment. Patients must be referred by EWC or by the Family Planning, Access, Care and Treatment Program (FPACT). Temporary Medi-Cal benefits are rapidly available in most cases, ensuring prompt treatment until final eligibility determinations are completed.
Expansion of EWC Services in California
Beginning January 1, 2017, with the implementation by California's legislature of AB 1795, EWC includes diagnostic services for women of any age who have symptoms of breast cancer. Previous eligibility required that women be 40 years or older. Symptoms may include a palpable mass, lump or swelling in the breast or underarm, change in size or shape of the breast; a change in skin texture or color of the breast, nipple discharge, or breast pain.
Education Services through EWC
In 2013-2014, 7,778 women attended EWC Health Education classes. The EWC referral line received 13,653 calls.
In addition to clinical services, EWC provides outreach and education to women across the state. These activities include health education classes, small group sessions, one-on-one consultations, the EWC toll-free information line, and the provider referral line and the EWC webpage.
The EWC Training Center is a collaborative effort of Every Woman Counts and the Institute for Public Health at San Diego State University. The EWC Training Center offers a variety of live and online training modules. These trainings feature tailored continuing education for a wide range of health professionals from clinicians to case managers to health educators.All online trainings are available to view for free. AMA PRA Category 1 Credits™, nursing CEUs, and/or CHES-CECHs are available for selected courses for a small fee.
Visit the EWC Training Center for valuable professional resources, including:
If you are interested in becoming an EWC provider, please contact the EWC Regional Contractor in your region. The EWC Regional Contractor in your area can be found on the EWC Regional Contractors page.
National Breast and Cervical Cancer Early Detection Program – NBCCEDP
The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) has been implemented in California through the Every Woman Counts program since 1991. The NBCCEDP provides Federal funding for EWC through the Centers for Disease Control and Prevention (CDC).
NBCCEDP was created in 1990 after the US Congress enacted the Breast and Cervical Cancer Mortality Prevention Act. The intent of the program is to reduce morbidity and mortality from breast and cervical cancer and to address the racial/ethnic disparities experienced within these two types of cancer. Ten years later, NBCCEDP expanded to include treatment for program-eligible women diagnosed with breast and/or cervical cancer.2
Currently, all 50 states, the District of Columbia, five US territories and 11 tribes/tribal consortia offer programs funded by NBCCEDP. These grantees, in turn, subcontract with a network of 10,000 health clinics and other health-care providers.2
Grantees collect standardized data that helps with program monitoring and evaluation, as well as policy development.3 Since 2005, performance-based funding has improved program services in a number of key areas.4
NBCCEDP programs have served more than 4.9 million women with breast and cervical cancer screenings and diagnostic services since 1991; through these screenings, nearly 71,000 breast cancers have been diagnosed.
NBCCEDP, through its grantees like EWC, reaches about 10% of eligible women.
Of all U.S. women, about 9.8% are eligible for breast cancer screening through the NBCCEDP but only a small percentage of eligible women (10.6%) are reached. Other screening programs account for about 30% of eligible women, but studies indicate that 6 of 10 U.S. women are not screened for breast cancer.5
NBCCEDP grantees, including Every Woman Counts, are making effective use of evidence-based interventions to ensure that women get screened and that follow-up services are provided in a timely manner:6
At least 80% of women are diagnosed within 60 days of an abnormal result.
94% of women have treatment initiated within 60 days of diagnosis.7
Although racial/ethnic disparities persist within the NBCCEDP program, progress is being made to reduce these differences, particularly in reaching American Indian and Alaskan Native women.7 NBCCEDP also appears successful in emphasizing regular screenings. These effects, while seen across women of all racial/ethnic groups, were strongest for Black women.8
California Department of Health Care Services. Every Woman Counts 2017 Report to the California legislature: breast and cervical cancer screening and diagnoistic services, fiscal year 2014-2015. http://www.dhcs.ca.gov/formsandpubs/Documents/Legislative%20Reports/Every%20Woman%20Counts%20Reports/EWC_Annual_Report_FY2014-15.pdf. Published February 2017. Accessed May 11, 2017
Lantz PM, Mullen J. The National Breast and Cervical Cancer Early Detection Program: 25 Years of public health service to low-income women. Cancer Causes Control. 2015;26(5):653-656.
Yancy B, Royalty JE, Marroulis S, Mattingly C, Benard VB, DeGroff A. Using data to effectively manage a national screening program. Cancer. 2014;120 Suppl 16:2575-2583.
DeGroff A, Royalty JE, Howe W, et al. When performance management works: a study of the National Breast and Cervical Cancer Early Detection Program. Cancer. 2014;120 Suppl 16:2566-2574.
White MC, Wong FL. Preventing premature deaths from breast and cervical cancer among underserved women in the United States: insights gained from a national cancer screening program. Cancer Causes Control. 2015;26(5):805-809.
DeGroff A, Carter A, Kenney K, et al. Using evidence-based interventions to improve cancer screening in the National Breast and Cervical Cancer Early Detection Program. J Public Health Manag Pract. 2016;22(5):442-449.
Richardson LC, Royalty J, Howe W, Helsel W, Kammerer W, Benard VB. Timeliness of breast cancer diagnosis and initiation of treatment in the National Breast and Cervical Cancer Early Detection Program, 1996-2005. Am J Public Health. 2010;100(9):1769-1776.
Adams EK, Bayakly AR, Berzen AK, et al. Enhancing screening and early detection among women transitioning to Medicare from the NBCCEDP in Georgia. Cancer Causes Control. 2015;26(5):795-803.
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