This application proposes to expand breast and cervical cancer screening and prevention services to include Permian Basin (COG-9) while maintaining services in the Panhandle (COG-1), South Plains (COG-2) and Central West Texas (COG-7) regions via Access to Breast and Cervical Care (ABC24WT) project by the Texas Tech University Health Sciences Center - Breast Center of Excellence (TTUHSC-BCE). Need: The human and economic burden of breast and cervical cancer in West Texas is stark; COG-1 has benefited significantly by the ABC24WT project since 2010. COG-2 and particularly COG-7 have largely Hispanic population with significantly higher breast cancer incidence (I) and mortality (M) for both br...

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This application proposes to expand breast and cervical cancer screening and prevention services to include Permian Basin (COG-9) while maintaining services in the Panhandle (COG-1), South Plains (COG-2) and Central West Texas (COG-7) regions via Access to Breast and Cervical Care (ABC24WT) project by the Texas Tech University Health Sciences Center - Breast Center of Excellence (TTUHSC-BCE). Need: The human and economic burden of breast and cervical cancer in West Texas is stark; COG-1 has benefited significantly by the ABC24WT project since 2010. COG-2 and particularly COG-7 have largely Hispanic population with significantly higher breast cancer incidence (I) and mortality (M) for both breast and cervical cancer [Breast - I=134.0 (state average=114.2), M=27.4 (state average=20.7); Cervix - I=9.7 (state average=9.2), M=3.2 (state average=2.8) per 100,000]. COG-9 demonstrates similar trend.

These statistics result from socioeconomic, educational, cultural and geographical barriers impeding access to healthcare. COGs 1, 2, 7, & 9 represent one of least covered area by CPRIT prevention grants. ABC24WT's strategic approach of public-private-community partnerships overcame these barriers current regions and is credited with approximately 39,000 direct educational contacts, 10,000 mammograms, 2,000 pap smears, and over 8,000 HPV shots. ABC24WT proposes to expand partnerships and replicate established strategies in COG-9. We will target the uninsured/underinsured population of the proposed region for education, awareness, screening and prevention through ABC24WT.

Overall Project Strategy: The strategy of public-private-community partnership created by the originally funded ABC24WT project, will be replicated for screening/prevention of breast and cervical cancer in COG-9. This model utilizes the evidence-based approaches of "Train the Trainer", culturally sensitive educational materials, community activists, and the "precede-proceed" models. Specifically, ABC24WT will target women and their families of COG-9 via an educational and awareness campaign similar to COGs 1, 2, & 7. County focused events will target women 40 and older for screening mammograms, 21-65 and older for screening Pap smears, and individuals 9-45 for HPV shots. Outreach and resource identification will be available to all income levels, but ethnic minorities and rural communities will be primary targets. The "no cost" services will be provided to uninsured/underinsured population who do not qualify for other indigent care funds.

Specific Goals: The overarching goal is to reduce the rate of advanced breast and cervical cancer in COGs-1, 2, 7 and 9. Measurable interim goals include (i) Increase the breast cancer screening rate of the target population for secondary prevention via early detection, (ii) Increase the cervical cancer screening rate of the target population for secondary prevention via early detection, and (iii) Increase in HPV shots for primary prevention of cervical cancer in the target population. We project to reach 500,000 people via non-interactive educational and outreach activities; and provide 43,500 services.

Significance and Impact: ABC24WT provides a scaffolding for the public-private-community partnership successful in COGs 1, 2, & 7 in addressing healthcare disparities. The impact is evident by the drop in advanced breast cancer rate from 20% to 5% and drop in mortality in COG-1. Combining the previous expansion, 154 breast and cervix cancers and precursors have been treated thus far. This model has also been successfully replicated in the San Angelo project; and now is credited with development of three dissemination products, namely: a project's director's guide, lay public training curriculum, and an outcome tracking database. The proposed expansion is likely to strengthen and expand partnerships and provide much needed access to healthcare in underserved regions of Texas. ABC24WT will ultimately reduce the human and economic burden of breast and cervical cancer in the target regions by decreasing incidence and mortality (as already evident in COG-1 where the project is active for a decade). By lowering advanced breast and cervical cancers in women, ABC24WT will tackle the economic burden on the state posed by treatment of advanced diseases in uninsured/underinsured population. Since early disease is curable, these women are likely to remain productive members of society. Many women originally served by ABC24WT ultimately became volunteers to help further the project's reach. Although the aim of ABC24WT project is to reduce breast and cervical cancer, we anticipate serendipitous advantages from community collaboration strengthening relationships for other projects important to local communities.

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