Identifying and exploring state policy issues in cervical cancer

Background: We know little about the policy issues at state level that impede cervical cancer efforts. This study identifies and explores state policy issues in cervical cancer to inform future policy and program strategies. Methods: Sixty minute key informant interviews were conducted with 15 professionals working in and around cervical cancer: federal and state government breast and cervical cancer programs; women's health and cancer control; national advocacy organizations engaged in sexual health and cancer; legislative affairs; researchers working in cervical cancer intervention and evaluation; state coalitions engaged in cervical cancer efforts; and partners from industry working on diagnostics, therapeutics or vaccines. Results: State policy issues included health system complexity; lack of state level cervical cancer program and policy coordination, and socio-organizational culture issues. System complexity was fueled by disparate and uncoordinated financing, controlled by different state programs/agencies. A paucity of state level coordination exacerbated by a lack of cervical cancer inter-agency/program influence prevented comprehensive, streamlined systems of care. Despite recent efforts to coordinate statewide cancer planning, cervical cancer issues and actors were not active in state priority setting. Socio-organizational cultural issues prevented normalization of HPV vaccine for boys and girls, as well as program and practitioner adoption of recent screening recommendations focused on identifying and monitoring persistent HPV. Conclusions: Identified state policy issues highlight needed collective attention on state systems and programs. Cross-agency, statewide planning could streamline systems for comprehensive cervical cancer vaccination, screening and treatment with coordinated funding and policy. Need to address leadership vacuum for cervical cancer efforts.