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The Cancer Screening Project

Antiretroviral therapy (ART) has changed the prognosis for all Human Immunodeficiency Virus (HIV) positive individuals. Today people living with HIV (PLWH) are living longer and aging. They are more at risk for cancer but less likely to get screened, treated, or survive.1 The Cancer Screening Project (CaSPr) aims to help by offering free coordination and navigation services for colorectal, cervical, breast, and lung cancer to PLWH in Michigan.

The Cancer Screening Project

  • Benji Raap

    Benji Raap has a master’s degree in public administration. Benji has over 10 years of public health experience including working as a community health worker, an HIV Medical Case Manager, and now with the Cancer Prevention and Control Section of the Michigan Department of Health and Human Services (MDHHS) as the Cancer Screening Project (CaSPr) Navigator. CaSPr aims to help people living with HIV (PLWH) get screened for colorectal, cervical, breast, and lung cancer in Michigan. When Benji is not working with patients or projects you can find him playing his cello and video games.

  • In order to refer a patient or client to the Cancer Screening Project (CaSPr) follow the steps listed below. 

    1. Have the patient or client sign your organization’s release of protected health information to:
      • The Cancer Screening Project
        109 W. Michigan Ave.
        5th floor, Lansing MI
        Phone: 517-512-5041
        Fax: 517-763-0290
    2. Fill out the Cancer Screening Project (CaSPr) Fax Cover Sheet and include your name, the number of pages being sent, a phone number that you can be reached at, and today’s date.
    3. Place the CaSPr Fax Cover Sheet over the release of information and fax the documents to 517-763-0290.

    You will receive a phone call verification once the document has been received by the CaSPr Navigator. CaSPr aims to complete phone call verifications within 24 hours.

  • Coordination

    Coordination services includes providing resources such as the name of a healthcare organization or provider that can complete the cancer screening recommended for you.

    Resources might include:

    • Cancer screening locations for all 83 counties in Michigan
    • HIV experienced and health equity trained primary care provider resources
    • Cancer screening resources in all 83 counties of Michigan

    Navigation

    Navigation services includes the process of completing a Cancer Screening Project (CaSPr) Assessment, service plan, and objectives dealing specifically with one or more of the following cancer screenings: colorectal, cervical, breast, and lung cancer. Navigation services must include a CaSPr Assessment, service plan, and at least one additional service from the options listed below:

    • Assessment: activities related to completing biopsychosocial assessment and acuity scale, completing consents and releases (if applicable).
    • Service Plan Development: activities related to completing the service plan at assessment or reassessment; this must be done every 6 months at minimum.
    • General Support: activities that do not easily fit into other categories listed here; can include: listening to client, providing support, advocating on client’s behalf, etc.
    • Treatment Adherence: activities related to assessing and addressing medication adherence issues.
    • Reassessment: activities related to updating client’s biopsychosocial areas and acuity scale, updating eligibility information, updating consents and releases (if applicable).
    • Monitoring: activities related to monitoring client’s service plan needs.
    • Discharge: activities related to terminating client’s services; can include discussing discharge with client and paperwork related to discharge.
    • HIV Specialist Confirmed: activities related to confirming that a client has attended a medical visit; only one unit should be used for each event. Confirming medical visits should not be done by client self-report alone, but verified with a medical clinic/provider to guarantee attendance. This unit must be entered for the date that the client attended the medical appointment, not for the date the appointment was verified.
    • Referral: activities related to providing a referral of ANY type, advocating on client’s behalf regarding referral, following up with referral source or client on referral outcome, and confirming referral was actualized.
    • Care Coordination: activities related to supervision, case conference, contact with client’s providers related to coordinating client’s service.
    • Health Education/Risk Reduction: activities related to assessing and addressing client’s risk reduction issues related to HIV, colorectal, cervical, breast, or lung cancers.
    • Housing Assistance: support for housing services that involve the provision of short-term assistance to support emergency, temporary, or transitional housing to enable an individual or family to gain or maintain medical care and/or cancer screening services.
    • Psychosocial Support: support for psychosocial support services that may include support and counseling activities; child abuse and neglect counseling; HIV support groups, cancer support groups; pastoral care/counseling; caregiver support; bereavement counseling.
    • Transportation Assistance: medical transportation service assistance that enables an eligible individual to access HIV related health support services, including services needed to maintain the client in HIV medical care, or cancer screening services through either direct transportation services, health insurance transportation assistance, and county health departments transportation assistance programs, etc. May be provided through use of volunteer drivers (through programs with insurance and other liability issues specifically addressed).
  • Risk Factors:  

    Factors that increase a woman’s risk for breast cancer include:

    • Personal or family history of breast or ovarian cancer
    • Dense breast tissue
    • Starting menstruation at a young age
    • Never giving birth or having first pregnancy after age 30
    • Drinking two or more alcoholic drinks a day
    • Specific genetic mutations (e.g. BRCA1 or BRCA2)

    Men can get breast cancer too, representing about 1% of new cases in Michigan from 2012-2016. Things that increase a men’s risk for breast cancer include:

    • Family history
    • Genetic mutations

    Screening: 

    • Who should get screened?
      • Screening for breast cancer is recommended for women of average risk starting at age 40. If risk factors are present, screening may be needed before the age of 40. Please consult your doctor.
    • What does this screening look like?
      • For women ages 40 and older, regular screening mammograms should be administered at intervals based on risk factors (every one to two years).
      • For women at high-risk of breast cancer, an MRI and mammogram annually may be recommended.
    • How can I get screened?
      • Under the Affordable Care Act (ACA), mammograms are covered by many insurances as part of preventive health care. Ask your doctor for more information.
      • The Breast and Cervical Cancer Control Navigation Program (BC3NP) provides breast cancer screening to low-income uninsured women between the ages of 40 and 64 years and also assists insured women in scheduling mammograms if needed. For more information about the BC3NP, please call toll free 844-446-8727 or visit BC3NP to see if you qualify.
  • Risk Factors:

    • Infection with one or more strains of Human Papilloma Virus (HPV); about 90% of cervical cancers are associated with HPV)
    • Smoking cigarettes
    • Multiple sex partners (regardless of sexual orientation)
    • Initiation of sex at age 16 or younger
    • First term pregnancy before age 17
    • Having three or more pregnancies
    • Not using condoms
    • Long-term use of oral contraceptives

    Screening:

    • Who should get screened?
      • Screening for cervical cancer is recommended for women of average risk between the ages 21-65.
    • What does this screening look like?
      • For women aged 21 to 29, Pap tests should be administered every three years.
      • For women aged 30 to 65 it is recommended to be screened every three years with a Pap test, OR every five years with high-risk human papillomavirus (hrHPV) testing alone, OR every five years with hrHPV testing in combination with a Pap test (co-testing).
    • How can I get screened?
      • Pap tests are available at family planning clinics, OBGYN offices, and most primary care clinics. Under the Affordable Care Act (ACA), these screenings are covered by many insurances.
      • The Breast and Cervical Cancer Control Navigation Program (BC3NP) provides cervical cancer screening to low-income uninsured women between the ages of 21-64. For more information about the BC3NP, please call toll free 844-446-8727 or visit BC3NP to see if you qualify.
      • The CaSPr Navigator can answer questions you might have about HIV and cervical cancer screening. You can contact the navigator at 517-512-5041.
  • Risk Factors:

    • Smoking (about 90% of lung cancers are associated with smoking)
    • Secondhand smoke exposure
    • Radon exposure
    • Exposure to certain chemicals (asbestos, arsenic, diesel exhaust, silica, and chromium are most common)
    • Family history of lung cancer
    • Prior diagnosis with lung cancer
    • Radiation therapy to the chest

    Screening:

    • Who should get screened?
      • Screening for lung cancer is recommended for people who are between 50 and 80 years old who have a 20 or more pack-per-year smoking history and currently smoke or have quit in the past 15 years.
      • If risk factors are present, screening may be needed before the age of 50. Please consult your doctor.
    • What does this screening look like?
      • Lung cancer screening is conducted with a low-dose spiral Computed Tomography (CT) Scan, which has been shown to decrease mortality from lung cancer through early detection.
    • How can I get screened?
      • The Cancer Screening Project (CaSPr) encourages you to speak with your doctor, nurse practitioner, or physician's assistant about your need for cancer screening services. An individual's age, family history, smoking history, personal life choices, physical ability, and many other factors affect the need for screening and that is why we ask that you speak with a health care provider.
      • Most health plans must cover a set of preventive services — like shots and screening tests. This includes plans available through the Health Insurance Marketplace. These services are covered only when delivered by a doctor or other provider in your plan’s network. If you have insurance questions, please contact the CaSPr Navigator at 517-512-5041. 
      • For more information about Lung Cancer, please visit Lung Cancer.
  • Risk Factors:

    • Being age 45 or older
    • Chronic inflammatory bowel disease
    • Family history of colorectal cancer
    • Lynch syndrome or Familial Adenomatous Polyposis
    • Smoking
    • Being overweight or obese
    • Having Type 2 diabetes
    • Eating diet high in red meat
    • African American race
    • Male sex assigned at birth
    • Ashkenazi Jewish heritage

    Screening:

    • Who should get screened?
      • Screening for colorectal cancer is recommended for people of average risk beginning at age 45. If risk factors are present, screening may be needed before the age of 45.
    • What does this screening look like?
      • There are several effective screening options available including:
        • Yearly: collect and submit a stool sample collected at home (Fecal occult blood test (FOBT), fecal immunochemical test (FIT), OR FIT DNA (Cologuard))
        • Every five years: flexible sigmoidoscopy OR CT colonography
        • Every ten years: colonoscopy OR flexible sigmoidoscopy with FIT every year
    • How can I get screened?
      • The Cancer Screening Project (CaSPr) encourages you to speak with your doctor, nurse practitioner or physician's assistant about your need for cancer screening services. An individual's age, family history, sexual history, personal life choices, physical ability, and many other factors affect the need for screening and that is why we ask that you speak with a health care provider. If you have questions about cancer screenings you can reach the CaSPr Navigator at 517-512-5041.
      • Most health plans must cover a set of preventive services — like shots and screening tests. This includes plans available through the Health Insurance Marketplace. These services are covered only when delivered by a doctor or other provider in your plan’s network. If you have insurance questions, please contact the CaSPr Navigator at 517-512-5041. 
  • If you have questions about the Cancer Screening Project (CaSPr), please contact MDHHS-cancerscreeningproject@michigan.gov or 517-512-5041.

1 Theresa W. Gillespie, Loree Mincey, Yuan Liu, Denise Ballard, Kimberly W. Scott, Robert Knott, Minh Ly T. Nguyen, Saurabh Chawla, Joseph Lipscomb, Jessica H. Wells. Survivorship care plan for cancer prevention and screening for people living with HIV (PLWH) [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-024.