Cervical cancer is a preventable disease with established evidence-based interventions including prophylactic vaccination as well as screening followed by treatment of pre-invasive disease [1-5]. In the U.S., cervical cancer incidence and mortality have decreased by approximately 70% over the last 40 years due to implementation of screening programs [4, 6-8]. However, medically-underserved areas have been unable to achieve this same success due to a lack of access to screening programs, limited public education, and insufficient referral and/or availability of trained personnel locally to perform the recommended diagnostic procedures and treatments. One such area is the Lower Rio Grand...

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Cervical cancer is a preventable disease with established evidence-based interventions including prophylactic vaccination as well as screening followed by treatment of pre-invasive disease [1-5]. In the U.S., cervical cancer incidence and mortality have decreased by approximately 70% over the last 40 years due to implementation of screening programs [4, 6-8]. However, medically underserved areas have been unable to achieve this same success due to a lack of access to screening programs, limited public education, and insufficient referral and/or availability of trained personnel locally to perform the recommended diagnostic procedures and treatments. One such area is the Lower Rio Grande Valley (LRGV) along the Texas-Mexico border where cervical cancer mortality is approximately 30% higher compared with non-border Texas counties [9].

We are proposing to implement two innovative, evidence-based, complementary interventions in the LRGV to increase public participation in cervical cancer screening and expand the professional capacity for accurate diagnosis and treatment of precancerous lesions. The first is Cultivando La Salud (Cultivating Health, CLS), an educational outreach program designed for promotoras to teach low-income Hispanic women about cervical cancer screening. This is combined with patient navigation services to facilitate connection with the cervical cancer screening services offered at our participating sites.

The second intervention is the implementation of Project ECHO to increase the number of community providers in the LRGV sufficiently trained and supported to manage abnormal cervical cancer screening tests including performing the recommended diagnostic and treatment procedures. ECHO (Extension for Community Healthcare Outcomes) is a well-established telementoring model proven to expand access to specialty medical care for underserved areas using videoconferencing, case-based learning and patient co-management. The Project ECHO model will be used to train and support local providers in the appropriate evaluation and management of abnormal cervical cancer screening tests.

Our proposal is a collaborative partnership involving Su Clínica Familiar (a Federally Qualified Health Clinic serving the poorest segment of the LRGV population), The University of Texas Health Science Center School of Public Health, Brownsville Regional Campus, The University of Texas Medical Branch, and MD Anderson Cancer Center. 

Goals include: 1: Implement Cultivando La Salud (CLS), an educational outreach intervention performed by promotoras to increase cervical cancer screening rates among medically-underserved women between the ages of 21 and 65 in the LRGV. • Objective 1: Educate 7,500 women on cervical cancer screening through implementation of the CLS program. • Objective 2: Increase the number of women undergoing cervical cancer screening with Pap +/- HPV testing by at least 30% (from 12,460 to 16,198).

Specific Goal 2: Employ the Project ECHO telementoring model to increase the delivery of local evidence-based cervical cancer prevention services by providing professional education, training and support of local providers caring for medically underserved populations in the LRGV. • Objective 1: Increase the number of local providers managing abnormal cervical cancer screening tests including performing colposcopy and cervical biopsies from 5 to 10. • Objective 2: Increase the number of local providers performing LEEPs from 0 to 3.

The major innovation of this project is the combination of two complementary, evidence-based programs (CLS and Project ECHO) to increase access to and delivery of cervical cancer preventive services. Our strategy is to integrate these interventions to increase cervical cancer screening through public outreach as well as improve the training and mentoring of local providers caring for this underserved population at high risk of cervical cancer.

We expect to demonstrate that public outreach using the CLS intervention will increase cervical screening rates in the LRGV. This will be combined with professional education, training and mentoring through Project ECHO, which will improve local professionals’ ability and confidence to deliver high-quality, evidence-based cervical cancer preventive services. We anticipate that these interventions will result in increased local rates of detection and treatment of preinvasive cervical disease, ultimately decreasing cervical cancer incidence and mortality in the LRGV. If successful, the combined interventions can be disseminated across Texas, the U.S., and globally to improve cervical cancer screening and preventive services.

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