Need: Texas has the 4th highest rate of cervical cancer incidence in the country and 7th highest mortality rate. Routine screening is the most effective way to detect cervical cancer early, when treatment is most effective, and in some cases, prevent it. In addition to screening, human papillomavirus (HPV) vaccination can also protect against high-risk HPV types that can lead to cervical and other cancers. While these primary and secondary prevention methods are proven to reduce cancer incidence and mortality, in Texas, 25% of women remain unscreened and less than 40% are up to date with the HPV vaccination series. Disparities are further observed across race, ethnicity, income, education le...

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Need: Texas has the 4th highest rate of cervical cancer incidence in the country and 7th highest mortality rate. Routine screening is the most effective way to detect cervical cancer early, when treatment is most effective, and in some cases, prevent it. In addition to screening, human papillomavirus (HPV) vaccination can also protect against high-risk HPV types that can lead to cervical and other cancers. While these primary and secondary prevention methods are proven to reduce cancer incidence and mortality, in Texas, 25% of women remain unscreened and less than 40% are up to date with the HPV vaccination series. Disparities are further observed across race, ethnicity, income, education level, and geography. The proposed Regional Expansion of Cervical Cancer Screening and Patient Navigation (E-XSPAN) aims to increase screening rates and access to care among these vulnerable populations in North Texas. The program will target rural, un/underinsured populations within a 67-county service area, providing screening, comprehensive navigation, and follow-up services. The region has been identified to include rural counties with the highest incidence rates, like Hill, and target public health regions where mortality is highest, including regions 2 and 4/5N. Overall Project Strategy: The E-XSPAN program will leverage existing framework, including community outreach and health promotion, comprehensive cervical cancer screening and follow-up care with nurse-driven clinical navigation through follow-up and treatment where appropriate, and centralized reimbursement for local providers. Our evidence-based program for cervical cancer screening will provide clinical services supported by telephone-based navigation to patients identified through targeted community outreach. In addition to working with community partners to identify eligible patients, we also continue to encourage participation from those residents not currently engaged in the healthcare system through our robust outreach and education efforts across the service area. Linkage to care will be navigated by the program team and delivered by clinical partners within the region. For regions where coverage gaps exist, the mobile health clinic is available to deliver screening services. E-XSPAN will provide multilevel support to facilitate completion of the screening episode as defined for cervical cancer, up to and including the first course of treatment. This patient-centered approach to quality metrics will standardize the evaluation approach, allowing for comparisons between organ sites and identify potential intervention points within the screening process to support optimization of delivery and improve screening process outcomes. In addition to expanding geography, service delivery will also expand to include HPV vaccination and education. Specific Goals: The primary intent of this proposal is to expand our successful comprehensive cervical cancer screening and navigation program to serve nearly 1.5 times the population and offer additional services, including HPV vaccination for age eligible patients. Specific goals:1) Optimize the delivery of cervical cancer screening services, overlaying a unified framework to our centralized process to identify and address key stress points across the screening continuum using patient-centered quality metrics; and 2) To address known barriers to care and improve participation in HPV vaccination across the service area. The project will reach more than 740,000 screen-eligible women, targeting those not current with screening. With CPRIT funds, the E-XSPAN program will provide at least 6,810 clinical services to more than 5,100 women. Services will include 3,255 screenings, using co-testing where appropriate, 3,375 follow-up services, and 180 HPV series immunizations. In addition to these services, the program will continue to leverage additional funds, including those available through our contract with Texas Breast and Cervical Cancer Service (BCCS). BCCS funds currently supports nearly half of services funded and will continue to supplement nearly 3000 screenings and 250 follow-up services for the program. Significance and Impact: Screening for precancerous cells and the early detection of cervical cancers continue to be the greatest defense against incidence and mortality. Building on the success of the original X-SPAN program, the expansion will create the opportunity for even more women to receive recommended clinical services through the removal of barriers such as cost, access, and the challenges of navigating the healthcare system while adding a primary prevention component of HPV vaccination. Leveraging existing infrastructure and the successful county-tailored delivery model will help to ensure prevention services reach those communities disproportionately impacted by cancer, including low-income, minority, uninsured or underinsured women residing in rural and underserved counties across North Texas.

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