Need: East Texas is a primarily rural, medically underserved area of Texas and is approximately the size of West Virginia (1). The population is disproportionately older with a larger proportion of non-Hispanic White and African American residents. Access to primary/specialty care is limited due to several factors: lack of providers, distance to health care facilities, and high rates of poverty (1). Breast cancer (BC) has disproportionately affected this area as well. BC is the most common type of cancer for women in Northeast Texas and the second most common cause of cancer deaths among women (19). For East Texans in general and especially for Non-Hispanic Blacks, BC incidence rates are hig...

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Need: East Texas is a primarily rural, medically underserved area of Texas and is approximately the size of West Virginia (1). The population is disproportionately older with a larger proportion of non-Hispanic White and African American residents. Access to primary/specialty care is limited due to several factors: lack of providers, distance to health care facilities, and high rates of poverty (1). Breast cancer (BC) has disproportionately affected this area as well. BC is the most common type of cancer for women in Northeast Texas and the second most common cause of cancer deaths among women (19). For East Texans in general and especially for Non-Hispanic Blacks, BC incidence rates are higher in the Northeast region than in the other regions of the State. A main reason behind differences in mammography screening rates in the U.S. is health insurance. Women who don't have health insurance are much less likely than women with health insurance to get mammograms. Mammography screening is important for all women, regardless of their race/ethnicity or their risk of BC. Along with follow-up tests, and treatment if diagnosed, mammography can reduce the chance of dying from BC (2). Black women have similar rates of screening mammography use as white women, Hispanic women, and Asian American women; however, the rate of BC mortality is higher in Black women in the US (5,6). Access to follow-up care after an abnormal mammogram may explain part of the survival gap between Black women and white women. Some findings have shown Black and African American women may have more delays in follow-up after an abnormal mammogram than white women (7-9). Even after accounting for differences in income and access to care, Black and African American women are diagnosed with more advanced BC and have worse survival rates than white women in the U.S. (10-13). When looking at Texas, blacks have cancer incidence and mortality rates that exceed those of whites and other racial/ethnic groups (14). Overall Project Strategy: This application will focus on recruiting underserved and uninsured women between 40 to 75 years of age, based on the current American Cancer Society (ACS) (13) guidelines. Unlike many BC screening projects, our current project will focus on mostly rural populations, which pose unique challenges related to access, delivery of education, and provision of BC screening services. We also focus on African American and black populations that have greater disparities related to BC. To achieve our level of success in this population we established numerous partnerships within the community which are visible, effective, and trusted by people in this region. We will use these techniques to provide education and access to the underserved in the 7-county area Specific Goals: This project has two goals: 1) Increase BC screening education in a 7-county mostly rural area of East Texas, and 2) increase the rate of BC screening in the 7-county mostly rural area of East Texas. We will provide screening to 1,220 patients and educate a minimum of 6,000 individuals and 600 professionals. Significance and Impact: As mentioned above, East Texas is in great need of a BC screening project due to the high rates of BC when compared to state averages. This project will demonstrate, in the 7 counties, that we are able to educate and screen individuals from this rural region with our unique approach. This project is unique and non-duplicative because most BC screening projects have focused on urban and suburban populations. Whereas urban BC screening projects generally focus on a more clinically driven approach to education and recruitment, we developed a unique integrated public health and clinical model which accounts for rurality and optimizes success. This project is also unique because of the focus on professional education regarding bias and racism in the healthcare system. Our focus will be on the African American population in rural East Texas that are faced with unique challenges related to access, delivery of education, and provision of BC screening services. Our access to care model incorporates strong partnerships with regional collaborators, incorporating numerous community health facilities to create awareness of BC screening options and recruit screening participants. Previous projects on cancer education, screening, and follow-up have been well received and effective in this region of East Texas. This project leverages the availability of robust primary care programs at The Health Science Center at UT Tyler (HSC) to assist with recruitment for BC screening. Other than ours, there are no known organized BC screening initiatives operating on a large scale in the targeted region which provide both BC education and screening services to the underserved. The proposal is designed to reach and serve as many individuals as possible with these potentially lifesaving screening activities.

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