Testimony by Ramanathan Raju, MD, FACS, MBA
Executive Vice President and Chief Medical Officer,
New York City Health and Hospitals Corporation

Good morning Chairpersons Rivera and Sears and members of the Committees on Health and Women’s Issues, I am Dr. Ramanathan Raju, Executive Vice President and Chief Medical Officer for the New York City Health and Hospitals Corporation (HHC). Thank you for the opportunity to discuss HHC’s efforts to screen patients for cervical cancer.

As many of you know, cancer is one of the ten most common causes of death. In 2005, 13,366 New Yorkers died from cancer (nearly one-quarter of all deaths). For New Yorkers between the ages of 35 and 64, cancer was the most common cause of death for both men and women in 2005. Nation-wide, cervical cancer accounted for 3,710 deaths in 2005. Cervical, breast and colon cancer are three areas where death rates are higher for low-income patients of color, largely due to access barriers to early detection of these cancers. Given these sobering statistics, HHC has been working aggressively to screen for cancer and conduct public health awareness campaigns. HHC continues to increase cancer screening efforts. Last year, HHC facilities provided more than 150,000 cervical cancer screenings and more than 80,000 mammograms. As a result, we are diagnosing significantly more cancers at an earlier stage when treatment is more effective and prognosis much more hopeful.

Cancer prevention in general is a particularly difficult process as the cause of most cancers are not immediately identifiable and the risk factors for developing cancer are numerous and vary with each cancer type. Thus, unlike common infectious diseases which had been largely controlled by immunization, cancer prevention continues to be a challenge. However, a new vaccine, the Human Papillomavirus (HPV) vaccine, has been approved by the U.S. Food and Drug Administration and recommended for use by the Centers for Disease Control and Prevention (CDC). The HPV vaccine has been proven to be efficacious in preventing certain types of HPV infection which account for 70% of cervical cancers and other diseases. The vaccine is recommended for girls and women between the ages of 11 and 26 and can be given to girls as early as 9 years old. The vaccine is administered in a series of three injections over a 6 month period.

In response to this promising cervical cancer prevention procedure, we, at HHC, have developed a four-point plan to promote the use of the HPV vaccine.

1. Increase Access to the HPV Vaccine
   • HHC will ensure the availability of HPV vaccine in pediatric, adolescent and adult primary care clinics for women and children between the ages of 11 and 26. We have ordered 10,270 doses of the vaccine from the VFC since November 2006, and as of the first week in March, we had 5,191 doses on hand. For children, the HPV vaccine is available from the federal Vaccine for Children (VFC) program; nearly 95% of HHC’s patients are eligible to receive free vaccine through this program which covers children who are either on Medicaid, uninsured, underinsured, Native American or an Alaska Native. In addition, more than 3,000 doses of additional vaccines have been purchased by facilities since the beginning of 2007 for those who are not eligible to receive the VFC vaccine (19 – 26 year old women). Approximately half of that supply has already been dispensed.
   • HHC will ensure that barriers to accessing vaccination are eliminated including a lack of or limited insurance coverage. Not all insurance plans include HPV vaccine coverage. HHC is committed to making this vaccine available regardless of a patient’s ability to pay or insurance plan; this policy is standard across all our facilities. HHC staff help patients enroll in available insurance programs if they are eligible. We also offer services at little or no cost through our HHC Options program. Girls under the age of 19 who have no health insurance can qualify for a free HPV vaccine at an HHC facility through the VFC program. In addition, patients under the age of 19 whose family income is up to 150% of the federal poverty level can see an HHC doctor or request vaccinations at no cost. Families whose incomes are between 150% and 400% above the federal poverty levels can visit an HHC doctor for reduced fees of $15 - $30 and can get the HPV vaccine for free.

2. Increase Public Education, Outreach and Enhanced Patient Literacy
   • HHC will be distributing linguistically and culturally appropriate printed materials to parents of children and young women for whom HPV vaccine is recommended. Materials from the CDC and the HPV vaccine manufacturer Merck are currently available in English, Spanish and Chinese. We are exploring having these documents translated into other languages. We will also have other multi-media materials on cervical cancer, HPV, and HPV vaccines in all clinical sites for parents of children and young women to review prior to their clinic visit. We will also distribute these materials in the communities we serve through community based organizations and other agencies in May 2007 during our campaign to increase awareness on breast and cervical cancer. Next week, we are meeting with members of the New York Immigration Coalition to discuss how we can work collaboratively on these activities. We will also be soliciting their collaboration in translating these materials into the native languages of their constituents.

3. Increase Provider Education
   • We are in the process of training our clinical staff about HPV and the HPV vaccine. In order to continue the dissemination of knowledge and skills among our clinical staff, a continuing medical education program on cervical cancer, HPV, and HPV vaccines is available for our clinical providers and materials on the efficacy, safety, and administration of HPV vaccine are available.
   • An entry for the HPV vaccine appears in the physician order entry section of our pediatric patients’ electronic medical record and we are in the process of expanding this to include adult patients.

4. Utilization Monitoring
   • In order to monitor the implementation of activities to provide the HPV vaccine, HHC will generate and review utilization reports.

This concludes my written testimony. I now look forward to answering any questions you may have.