Need: Colorectal cancer (CRC) is the second leading cause of cancer deaths in the US and Texas. In 2021, there will be an estimated 11,280 new cases of CRC and approximately 4,030 deaths in Texas. Up to 90% of deaths from CRC may be avoidable with CRC screening. Evidence is strong that CRC screening reduces CRC mortality by permitting identification and removal of precancerous polyps and by revealing CRC at early stage when it is most curable.1 When detected early, CRC has a 5-year survival rate of up to 90%,2 however, only 39% of cases in Texas are diagnosed at this stage. The proportion diagnosed at an advanced stage is 20% in Texas, largely due to the underuse of evidence-based screening ...

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Need: Colorectal cancer (CRC) is the second leading cause of cancer deaths in the US and Texas. In 2021, there will be an estimated 11,280 new cases of CRC and approximately 4,030 deaths in Texas. Up to 90% of deaths from CRC may be avoidable with CRC screening. Evidence is strong that CRC screening reduces CRC mortality by permitting identification and removal of precancerous polyps and by revealing CRC at early stage when it is most curable.1 When detected early, CRC has a 5-year survival rate of up to 90%,2 however, only 39% of cases in Texas are diagnosed at this stage. The proportion diagnosed at an advanced stage is 20% in Texas, largely due to the underuse of evidence-based screening strategies.2

Despite improvement over time Texas colorectal cancer screening rates rank only 48th nationally reflecting some of the challenges associated with our high rates of uninsured, low resource and highly diverse vulnerable populations. Interventions to increase colorectal cancer screening (CRCS) are still needed. Though prevention and early detection have lessened Texas CRC incidence and mortality rates, not all populations have benefited equally. Screening rates remain below recommended levels, especially for low-income, uninsured, those in rural/frontier areas, African American and Hispanic populations.

Overall Project Strategy: The Alliance for Colorectal Cancer Testing 3.0 (ACT 3.0) is a Regional Coalition of Clinical Service Providers utilizing an evidence-based approach to increase CRC screening through fecal immunochemical test (FIT)-based screening followed by colonoscopy. Our program has successfully leveraged collaborations with the American Cancer Society and the UT School of Public Health and engaged a broad network of primary care safety net clinics and endoscopy providers to successfully deliver colorectal cancer screening services to CPRIT priority populations. The project also facilitates a statewide alliance of organizations working toward raising CRC screening rates called the Texas Alliance for Colorectal Cancer Testing (TACCT). TACCT meets regularly to identify and share best practices and discuss solutions to common problems. We will expand our existing CPRIT funded screening network ACT 2.0 operating in south, central, and east Texas by integrating clinics in a 9-county area (including Houston/Harris County) that are currently engaged in a second CRC screening initiative supported by MD Anderson through the Texas 1115 Waiver. The total expanded geographic service area for ACT 3.0 will include 63 counties in Central, East, Southeast and West Texas with over 140 individual clinic sites. The ACT 3.0 program will work with our clinics to restore screening levels adversely impacted by COVID-19 and increase screening activities by 15% per year from the baseline level for calendar year 2020. The screening protocol used is based on US Preventive Services Task Force recommendations using FIT followed by colonoscopy for positive tests. Patients at increased risk will be referred directly to colonoscopy. Polypectomy is provided when clinically indicated as well as surveillance endoscopy. Participants are supported with navigation services to ensure provision of diagnostic services and treatment if needed.

Specific Goals: 1: Expand our clinical services in collaboration with Federally Qualified Health Centers (FQHCs), community clinics and specialty providers and other partners, including MD Anderson, UTHealth School of Public Health and the American Cancer Society, to increase colorectal cancer screening (CRCS) and decrease CRC incidence and mortality disparities in higher risk, rural and/or underserved populations. 2: Implement system and clinical practice changes to provide timely access for evaluation of positive FIT results through navigation services to colonoscopy and treatment if needed. 3: Provide guidance for a statewide alliance of organizations involved in CRCS in Texas (Texas Alliance for Colorectal Cancer Testing). Significance and Impact: Through a comprehensive approach including system and clinical practice changes this project will continue to enable primary care practices to recommend, promote and facilitate CRC screening. Our program covers the cost of the FIT test, follow-up colonoscopy and polypectomy for low-income, uninsured patients. This comprehensive approach is supported by coordination of endoscopists and navigation for patients. MD Anderson is committed to providing significant financial support to the combined programs greatly enhancing the impact of this essential CPRIT funded project.

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