Improving women’s cancer prevention services (screening and education) in rural areas and among health-disparate populations has been the focus of significant and prolonged concern in Texas. Low-income women residing in rural and medically underserved areas of Texas suffer from significantly higher incidence and mortality rates associated with breast and cervical cancer. Family medicine physicians, nurses and nurse practitioners, and community health workers (CHWs) working in these areas play an important role in ensuring provision of breast and cervical cancer screenings, related diagnostics, and HPV vaccination.

This project will allow the Texas A&M Family Medicine Residency, Colleg...

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Improving women’s cancer prevention services (screening and education) in rural areas and among health-disparate populations has been the focus of significant and prolonged concern in Texas. Low-income women residing in rural and medically underserved areas of Texas suffer from significantly higher incidence and mortality rates associated with breast and cervical cancer. Family medicine physicians, nurses and nurse practitioners, and community health workers (CHWs) working in these areas play an important role in ensuring provision of breast and cervical cancer screenings, related diagnostics, and HPV vaccination.

This project will allow the Texas A&M Family Medicine Residency, College of Nursing, and School of Public Health to provide evidence-based breast and cervical cancer screening and diagnostic services, education, and patient care and navigation, through a unique interdisciplinary training program housed in an academic family medicine residency clinic.

If funded, Texas A&M will continue to provide these to safety-net women in nine counties of Texas, while expanding services to eight contiguous counties, seven of which are classified rural. Texas A&M has a well-established network of clinical and community partners in these “new” counties, through its Texas Cancer Screening, Training, Education and Prevention program (Texas C-STEP).

Building on strengths of our academic medical, nursing and public health programs, and their clinical and community partners, we will facilitate education on, access to, and provision of breast and cervical cancer screening and diagnostic services, across the continuum of care, for low-income women in 17 largely-rural Texas counties, while providing interdisciplinary training (both simulated and live) to family physician residents, nursing and nurse practitioner students, and CHWs.

Specific goals of this application are to: 1) increase (by up to 2,400) the number of breast and cervical cancer screenings and follow-up diagnostics, provided to at least 1,500 low-income, underserved and rural women in Texas; 2) improve access to B&CC prevention education (by at least 120,000 people), HPV vaccination (by at least 900 people), screening, and follow-up care and navigation using a CHW model; and 3) increase by more than 200 the pool of nursing students, family medicine physicians and nurse practitioners who receive direct training in prevention education, and breast and cervical cancer screenings or diagnostic procedures.

Texas C-STEP currently serves 17 Texas counties through a CPRIT-funded colonoscopy screening/outreach/education program (PP150025), while serving only nine of those same counties for women’s health services (PP130090). Expanding women’s health services to the entire C-STEP service area will involve the addition of eight counties.  In Falls, Freestone & Limestone Counties, the support of Limestone Medical Center will ensure referrals for mobile mammography, as well as advanced diagnostic services to be done at Texas A&M Physicians. There are no federally qualified health centers (FQHCs) in these three rural counties and two of the three counties have only one CPRIT project per the 05/2016 CPRIT portfolio map.

In Houston & Trinity County, Texas C-STEP will partner with Murray Community Clinic in Crockett, which serves the poor and uninsured and is staffed by volunteer physicians and physician residents from Texas A&M. Nearly 1⁄4 of Houston County residents are African American; 20% live below poverty level. Clinical and community partners for Lee & Milam County expansion are based in Rockdale, Lexington, and Giddings; both counties have only one CPRIT prevention project. We will also expand to Waller County, where 54% are Hispanic or African American and 23% live in poverty.

Working through a family medicine residency clinic venue is unique because of its patient-centered medical home organizational model, designed to improve patient access, knowledge, and ability to navigate the healthcare system. Using a network of trained CHWs, our C-STEP patient education services will be utilized to overcome potential barriers such as fear, medical mistrust, or indifference about preventative screening. Transportation partners for our service area are described in the grant application.

The sheer numbers of breast and cervical cancer-related preventive services associated with this project may dramatically contribute to early detection of breast and cervical cancer and reduction of mortality rates for this area of Texas. This interdisciplinary screening and prevention program may also serve as a state and national model for addressing the significant need for greater numbers of providers, nurses, public health professionals, and CHWs who are trained in various aspects of evidence-based cancer prevention and care – with a focus on low-income, safety-net women in rural and underserved areas.

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