This application proposes to continue breast cancer screening/prevention services, and expand the network to include cervical cancer screening/prevention services for the population of Council of Government-1 (COG-1) by the Texas Tech University Health Sciences Center – Breast Center of Excellence (TTUHSC-BCE).

The human and economic burden of breast and cervical cancer in COG-1 is stark;breast cancer incidence is lower than state average at around 57/100,000 women but the mortality is higher at 13/100,000. This paradox is the result of lack of access to screening/early detection for the largely underserved population. Similarly, cervical cancer is one of the highest incidence (12/100,...

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This application proposes to continue breast cancer screening/prevention services, and expand the network to include cervical cancer screening/prevention services for the population of Council of Government-1 (COG-1) by the Texas Tech University Health Sciences Center – Breast Center of Excellence (TTUHSC-BCE).

The human and economic burden of breast and cervical cancer in COG-1 is stark;breast cancer incidence is lower than state average at around 57/100,000 women but the mortality is higher at 13/100,000. This paradox is the result of lack of access to screening/early detection for the largely underserved population. Similarly, cervical cancer is one of the highest incidence (12/100,000) and highest mortality (4/100,000) areas in Texas. The coverage for HPV vaccination in COG-1 is less than 14% for at least one dose compared to Texas average of 18% which is much worse compared to the national average of 53%. These statistics result from socioeconomic, educational, cultural and geographical barriers impeding access to healthcare.

ABC4WT network's strategic public-private-community partnerships that overcome these barriers, provided 2,631 services, increasing screening compliance from 57% to 59%; and dropped the at risk population to 26% compared to 29% state average. ABC24WT proposes to expand partnerships to include the cervical care community, and replicate established strategies into the cervical screening/prevention arena, while continuing breast screening. Many women’s healthcare provider offer both breast and cervical services; this network is easily scalable to cervical care.

We will target the uninsured/underinsured population of COG-1 for education, awareness, screening and prevention through ABC24WT. The overarching strategy for screening/prevention for the underserved population is a unique model of public-private-community partnership created by the originally funded ABC4WT project. This model utilizes the evidence-based approaches of “Train the Trainer” model, culturally sensitive educational materials, community activists, and the “precede-proceed” model.

This model is proposed to now include the cervical care community. Specifically, ABC24WT will target women and their families of COG-1 via an educational and awareness campaign. County focused events would partner with local providers and target the women 40 and older for screening mammograms, 21 and older for screening Pap smears, and females 9-26 for HPV vaccination. Women at high risk for breast and/or cervical cancer will be offered counseling. Outreach and resource identification will be available to all income levels, but ethnic minorities and rural communities form a particular target. The “no cost” services will be provided to uninsured/underinsured population who do not qualify for other indigent care funds available.

The ultimate goal is to reduce the human and economic burden of breast and cervical cancer in COG-1. Measurable interim goals include (1)expanding the Texas Panhandle breast care network to include the cervical care community, (ii)increase the use of breast and cervical prevention counseling, and (iii) increase the breast and cervical cancer screening rates. We project to reach 150,000 people via non-interactive educational and outreach activities; and 23,533 people via direct educational activities and services.

ABC24WT provides significant scaffolding for the public-private-community partnership model. This model has already proved successful in breast cancer screening/prevention. The impact is evident by the drop in advanced breast cancer rate from 20% to 5% in the target community over last 3 years. This success led to replication of our model at a San Angelo project, funded by CPRIT. The proposed expansion is likely to strengthen and expand partnerships, and provide much needed access to healthcare in underserved parts of Texas.

ABC24WT will ultimately reduce the human and economic burden of breast and cervical cancer in the Texas Panhandle by decreasing the incidence and mortality. 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 served by ABC4WT ultimately became volunteers to help further the reach of the project.

Although the target of ABC24WT is to reduce breast and cervical cancer burden, we anticipate serendipitous advantages from increasing HPV vaccinations. Other cancers attributable to HPV include 80-85% of anal cancers,50% of penile cancers, 36-40% vulvar cancers, 90% of vaginal cancers, in addition to oropharyngeal cancers, accounting for almost 5% of all cancers. Breaking the chain of HPV infections through vaccination is likely to reduce the burden of all HPV related cancers.

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