Getting Started

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Model state genomics programs have identified important first steps for states beginning Tier 1 programs to consider.

Identify existing priorities and activities in your state:

  • Review your state comprehensive cancer control plan (CCP) and heart disease and stroke plan to identify objectives related to Tier 1 applications.
  • Review the CDC clickable map of state genomics activities to identify existing Tier 1 activities and resources in your state.

Identify potential activities and partners:

  • Review the strategies provided in this toolkit and choose one that best meets your state’s needs.
  • Network with potential partners to identify the needs in your state.
  • Contact your state or local cancer registry to see if existing data can be used for cancer genomics surveillance and education to promote the Healthy People 2020 cancer genomics objectives.
  • Work with health plans and health care providers in your state to develop evidence-based policies that promote the Healthy People 2020 cancer genomics objectives.

Activities in the Toolkit are divided into Phase 1 and 2:

Phase 1 approaches identify individuals at risk

Phase 1 approaches generally address identifying individuals (index cases) who could benefit from Tier 1 genomic applications. With a relatively few resources, state, district and territorial public health departments can take evidence-based actions to begin saving lives now. A few “pioneer” states have already implemented these important steps and others can learn from their work. Phase 1 approaches include:

  • Bi-directional cancer registry reporting with partner provider systems for case finding or other purposes
  • Informing policy making, such as evidence-based coverage by payers for services specified by Tier 1 recommendations
  • Developing and tracking surveillance indicators to follow progress in achieving widespread implementation of Tier 1 recommendations and the Healthy People 2020 objective
  • Designing and implementing educational outreach programs targeting the general public and health professionals with interest in Tier 1 applications.

Phase 2 approaches identify families at risk

In Phase 2, states with mechanisms in place to identify index cases, such as those described in Phase 1, develop approaches to identify the at-risk family members of index cases who can benefit from evidence-based preventive strategies through cascade screening. While the challenges and opportunities differ by state, success in any of these efforts requires establishing partnerships among public health, healthcare providers and payers within each state.

Ready to get started? Learn more about implementing genomics activities for Lynch syndrome, Hereditary Breast and Ovarian Cancer, and Familial Hypercholesterolemia.