[Federal Register Volume 59, Number 65 (Tuesday, April 5, 1994)]
[Unknown Section]
[Page 0]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-8057]


[[Page Unknown]]

[Federal Register: April 5, 1994]


-----------------------------------------------------------------------

DEPARTMENT OF HEALTH AND HUMAN SERVICES
[Announcement 425]

 

1994 Capacity Building for Core Components of Breast and Cervical 
Cancer Prevention and Control Programs

Introduction

    The Centers for Disease Control and Prevention (CDC) announces the 
availability of fiscal year (FY) 1994 funds for new competing 
cooperative agreements to initiate capacity building for the core 
components of comprehensive breast and cervical cancer control 
programs.
    The Public Health Service (PHS) is committed to achieving the 
health promotion and disease prevention objectives of ``Healthy People 
2000,'' a PHS-led national activity to reduce morbidity and mortality 
and improve the quality of life. This announcement is related to the 
priority area of Cancer. (To order a copy of ``Healthy People 2000,'' 
see the section Where to Obtain Additional Information.)

Authority

    This program is authorized under section 301(a) (42 U.S.C. 241(a)), 
section 317(k)(3) (42 U.S.C. 247b(k)(3)), and section 1501 (42 U.S.C. 
300k) of the Public Health Service Act, as amended.

Smoke-Free Workplace

    The Public Health Service strongly encourages all cooperative 
agreement recipients to provide a smoke-free workplace and promote the 
non-use of all tobacco products. This is consistent with the PHS 
mission to protect and advance the physical and mental health of the 
American people.

Eligible Applicants

    Eligible applicants are the official public health agencies of the 
five States of Idaho, Kentucky, Nevada, South Carolina and Tennessee or 
their bona fide agents or instrumentalities and the District of 
Columbia, American Samoa, the Commonwealth of Puerto Rico, the Virgin 
Islands, the Federated States of Micronesia, Guam, the Northern Mariana 
Islands, the Republic of the Marshall Islands, and the Republic of 
Palau. All other States were previously funded under Program 
Announcement Numbers 121, 122, 221, and 321 entitled ``Early Detection 
and Control of Breast and Cervical Cancer,'' in FY 1991, 1992, and 
1993, and are not eligible to compete for funding under this program 
announcement.

Availability of Funds

    Approximately $1,200,000 is available in FY 1994 to fund 
approximately 7 awards. It is expected that the average award will be 
$170,000, ranging from $150,000 to $200,000. It is expected that the 
awards will begin on or about June 30, 1994, and will be made for a 12-
month budget period within a project period of up to 3 years. Funding 
estimates may vary and are subject to change.
    Continuation awards within the project period are made on the basis 
of satisfactory progress and availability of funds.
    Funding preference will be given to applications from State health 
departments who are in the initial planning phase for statewide breast 
and cervical cancer screening.
    At the request of the applicant, Federal personnel may be assigned 
to a project in lieu of a portion of the financial assistance.

Purpose

    The purpose of these cooperative agreements is to support State 
health departments in their efforts to develop their capacity to carry 
out a program for early detection and control of breast and cervical 
cancer. The intent is to initially enable States to build the necessary 
infrastructure towards providing a comprehensive breast and cervical 
cancer early detection program. Resources available under this program 
announcement may not be used to support screening and follow up 
services for breast and cervical cancer.

Program Requirements

    In conducting activities to achieve the purpose of this program, 
the recipient shall be responsible for the activities under A., below, 
and CDC shall be responsible for conducting activities under B., below:

A. Recipient Activities

    The following six elements are essential and integral components in 
the development of a State-based comprehensive breast and cervical 
cancer control program. Planning for conducting the core components 
must occur during the first and second year, with implementation begun 
by completion of the project period.

1. Breast and Cervical Cancer Control Plan and Coalition

    In developing a comprehensive breast and cervical cancer control 
program, the applicant should include the following:
    a. A State level breast and cervical cancer control coalition 
including representation from key private, professional, voluntary and 
public (e.g., American Cancer Society) cancer organizations, 
legislators, and consumers.
    b. A proposed breast and cervical cancer control plan that 
describes:
    (1) Goals and objectives to address breast and cervical cancer 
control.
    (2) Proposed strategies to meet those objectives.
    (3) An assessment of existing and needed resources to develop the 
comprehensive breast and cervical cancer control program.

2. Public Education

    A plan for a comprehensive public education program based on an 
assessment of the target populations educational needs. Successful 
public education programs are those that influence knowledge, 
attitudes, and practices related to breast and cervical cancer 
screening adherence in target populations by utilizing all available 
resources which may include, but are not limited to, the American 
Cancer Society, State medical societies, and universities.

3. Professional Education

    A plan for conducting an assessment of the health care providers to 
determine important practice information useful in developing an 
education program. This could include: (1) Screening behaviors in their 
practices; (2) Knowledge of screening guidelines; (3) Use of screening 
reminder systems; (4) Laboratories used for reading Pap smears; and (5) 
Sites of mammography referrals.
    After the health care provider assessment has been conducted, 
States should collaborate with appropriate professional groups and 
organizations to develop a provider education program. The development 
of a health provider education program would transmit information on 
the efficacy and appropriate use of screening procedures and reminder 
systems for providers.
    Participate in the CDC sponsored training workshops and meetings by 
ensuring that appropriate representatives attend using travel funds 
provided through this cooperative agreement.

4. Quality Assurance

    In preparation for developing a statewide quality assurance 
component: (1) Conduct a statewide assessment to determine the current 
status and identify areas of need in mammography and cervical cytology 
quality assurance; and (2) Develop the components of a comprehensive 
quality assurance program based on guidelines developed by CDC.

a. Mammography

    The achievement of mammography's full potential contribution to the 
process of early breast cancer detection requires that quality 
assurance procedures be systematically applied in routine practice. 
Mammography quality assurance encompasses the importance of the design, 
function, and operation of equipment, patient and provider 
communication, image quality, interpretation of the mammogram, 
communication of the radiologist's interpretation, and record keeping.
    The minimal quality level for mammography shall include the 
following criteria:
    (1) Properly trained and experienced personnel.
    (2) Proper use of appropriate, well-maintained, dedicated 
equipment.
    (3) Periodic performance evaluation tests of the imaging system 
following guidelines recommended by the American College of Radiology.

b. Cervical Cytology

    The minimal quality level for cervical cytology shall include the 
following criteria:
    (l) Properly trained, accredited, and certified personnel.
    (2) Licensed laboratories that maintain an ongoing quality 
assurance program, to include provisions for alternative cervical 
cancer screening techniques if such systems are used by the 
participating laboratories.
    (3) Appropriate reporting and communication of results.

5. Surveillance

    States should assess current capabilities and develop a plan to 
ensure that changes in disease burden and screening behavior can be 
adequately monitored. To do this, a surveillance system should:
    a. Collect population-based information on race, incidence, staging 
at diagnosis, and mortality from breast and cervical cancers.
    b. Identify population segments at higher risk for disease and for 
failure to be screened.
    c. Identify factors that contribute to disease burden and limited 
or inequitable access to early detection and treatment services.
    d. Monitor the number and characteristics of women screened and 
outcomes of screening.
    e. Monitor screening resources, including the number of mammography 
facilities, cytology laboratories, and providers of cytology screening.
    f. Design and conduct case studies and other epidemiologic 
investigations to determine factors associated with avoidable morbidity 
and mortality.
    g. Publish a yearly report summarizing the population status with 
respect to these conditions.

6. Evaluation

    Attention should be given to the development, establishment, and 
design of individual components to ensure that there can be meaningful 
evaluation. The evaluation plan should assess the performance and 
effectiveness of intervention components, including:
    a. Coalition development.
    b. Cancer plan development.
    c. Public education.
    d. Professional education.
    e. Quality assurance.
    f. Surveillance.
    At a minimum, the evaluation plan should assess the existing State 
breast and cervical cancer control program and should include the 
following:
    a. A description of the evaluation plan and how evaluation results 
will be used.
    b. A description of methods used to assess the development of 
program activities in all program components.

B. CDC Activities

    1. Convene meetings for representatives of States receiving awards 
for workshops and sharing information.
    2. Convene meetings for representatives of States receiving awards 
for training purposes.
    3. Disseminate to State health departments relevant state-of-the-
art research findings and public health recommendations that relate to 
early detection, diagnosis, and treatment for breast and cervical 
cancer.
    4. Collaborate with recipients in planning, operating, and 
evaluating program activities and coordinating projects' participation 
in all components of the cancer program.
    5. Collaborate with recipients in developing surveillance and data 
systems and in the States' analysis and evaluation of data.
    6. Provide technical assistance in the development of public and 
professional education components.
    7. Collaborate with recipients in disseminating outcome indicators 
and their integration into program operation.
    8. Provide guidance in the development and establishment of 
specific morbidity reduction objectives.
    9. Provide technical information and guidelines in the development 
of quality assurance procedures for mammography and cervical cytology.
    10. Provide technical assistance and direction in the development 
of evaluation efforts.

Evaluation Criteria

    Applications will be reviewed and evaluated according to the 
following criteria:
    1. The capability of the State health department's commitment to 
carry out the planning, intervention, and evaluation process and the 
overall plan to accomplish this process. (10 points)
    2. The extent to which the applicant assesses the breast and 
cervical cancer program needs of the target population and justifies 
the program's focus on the target population. (10 points)
    3. The consistency of the specific and time-related, measurable 
objectives with the stated purpose of the cooperative agreement and the 
ability to achieve the objectives, activities, and milestones of the 
program within the specified period. (15 points)
    4. The extent of the applicant's ability to assure community and 
professional support and involvement, to use available resources, and 
to ensure that the coalition assumes a major role in the program. (10 
points)
    5. The ability of the applicant to identify appropriate staff for 
the program who are available and trained to carry out the required 
task. (5 points)
    6. The extent to which the applicant's plan reflects integration of 
breast and cervical cancer program elements into the health care 
delivery system through the formation of program linkages and the 
development of a cancer program advisory group or task force. (10 
points)
    7. Evidence of the applicant's commitment to develop and maintain a 
surveillance system, a breast and cervical cancer registry, and a 
method to track the knowledge, attitudes, and practices of the targeted 
population. (10 points)
    8. The quality of the public education plan, including the ability 
to develop, carry out, and evaluate interventions for target 
populations. (5 points)
    9. The quality of the professional education plan, including the 
ability to develop, carry out, and evaluate interventions for target 
populations. (5 points)
    10. The quality of the mammography and cervical cytology quality 
assurance plan. (10 points)
    11. The quality of the applicant's evaluation plan. (10 points)
    12. The extent to which the budget is reasonable and consistent 
with the intended use of cooperative agreement funds. (Not Weighted)

Recipient Financial Participation

    This program has no statutory formula. No specific matching funds 
are required; however, the application should include specifics on the 
applicant's contribution to the overall program cost and reflect a 
commitment to long-term progressive support on the part of non-Federal 
funding sources.

Executive Order 12372 Review

    Applications are subject to Intergovernmental Review of Federal 
Programs as governed by Executive Order (E.O.) 12372. E.O. 12372 sets 
up a system for State and local government review of proposed Federal 
assistance applications. Applicants should contact their State Single 
Point of Contact (SPOC) as early as possible to alert them to the 
prospective applications and receive any necessary instructions on the 
State process. For proposed projects serving more than one State, the 
applicant is advised to contact the SPOC for each affected State. A 
current list of SPOCs is included in the application kit. If SPOCs have 
any State process recommendations on applications submitted to CDC, 
they should forward them to Edwin L. Dixon, Grants Management Officer, 
Grants Management Branch, Procurement and Grants Office, Centers for 
Disease Control and Prevention (CDC), 255 East Paces Ferry Road, NE., 
Atlanta, Georgia 30305, no later than 60 days after the application 
deadline date. The granting agency does not guarantee to ``accommodate 
or explain'' for State process recommendations it receives after that 
date.

Public Health System Reporting Requirement

    This program is not subject to the Public Health System Reporting 
Requirements.

Catalog of Federal Domestic Assistance Number

    The Catalog of Federal Domestic Assistance number is 93.283.

Other Requirements

Paperwork Reduction Act

    Projects that involve the collection of information from 10 or more 
individuals and funded by cooperative agreement will be subject to 
review by the Office of Management and Budget (OMB) under the Paperwork 
Reduction Act.

Application Workshop

    CDC will conduct an application workshop for potential applicants 
via conference calls. The workshop will address specifics of the 
program announcement and provide attendees with guidance on the 
assessment, planning, and development of infrastructure and each of the 
essential core components of a comprehensive breast and cervical cancer 
control program. Those wishing to participate in the conference calls 
must register by contacting Tanya Hicks at (404) 488-4880. For 
additional information please refer to the ``Where To Obtain Additional 
Information'' section of this announcement.

Application Submission and Deadline

    The original and two copies of the application PHS Form-5161-1 must 
be submitted to Edwin L. Dixon, Grants Management Officer, Grants 
Management Branch, Procurement and Grants Office, Centers for Disease 
Control and Prevention (CDC), 255 East Paces Ferry Road, NE., Room 314, 
Mailstop E-18, Atlanta, Georgia 30305, on or before May 25, 1994.

1. Deadline

    Applications shall be considered as meeting the deadline if they 
are either:
    (a) Received on or before the deadline date; or
    (b) Sent on or before the deadline date and received in time for 
submission to the independent review group. (Applicants must request a 
legibly dated U.S. Postal Service postmark or obtain a legibly dated 
receipt from a commercial carrier or U.S. Postal Service. Private 
metered postmarks shall not be acceptable as proof of timely mailing.)

2. Late Applications

    Applications which do not meet the criteria in 1.(a) or 1.(b) above 
are considered late applications. Late applications will not be 
considered in the current competition and will be returned to the 
applicant.

Where To Obtain Additional Information

    A complete program description, information on application 
procedures, an application package, and business management technical 
assistance may be obtained from Nealean K. Austin, Grants Management 
Specialist, Grants Management Branch, Procurement and Grants Office, 
Centers for Disease Control and Prevention (CDC), 255 East Paces Ferry 
Road, NE., Room 314, Mailstop E-18, Atlanta, Georgia 30305, telephone 
(404) 842-6508.
    Programmatic technical assistance may be obtained from Kevin Brady, 
Program Services Branch, Division of Cancer Prevention and Control, 
National Center for Chronic Disease Prevention and Health Promotion, 
Centers for Disease Control and Prevention (CDC), 4770 Buford Highway, 
NE., Mailstop K-57, Atlanta, Georgia 30341, telephone (404) 488-4880 
and FAX (404) 488-4727.
    Please refer to Announcement Number 425 when requesting information 
and submitting an application.
    Potential applicants may obtain a copy of ``Healthy People 2000'' 
(Full Report; Stock No. 017-001-00474-0) or ``Healthy People 2000'' 
(Summary Report; Stock No. 017-001-00473-1) referenced in the 
Introduction through the Superintendent of Documents, Government 
Printing Office, Washington, DC 20402-9325, telephone (202) 783-3238.

    Dated: March 30, 1994.
Robert L. Foster,
Acting Associate Director for Management and Operations, Centers for 
Disease Control and Prevention (CDC).
[FR Doc. 94-8057 Filed 4-4-94; 8:45 am]
BILLING CODE 4163-18-P