Breast cancer is the leading cause of cancer among women in the US (excluding non melanotic skin cancers), is the second commonest cause of cancer deaths in women overall and is the leading cancer killer among Hispanic women. Our target population resides in El Paso County (EPC) and Hudspeth County (HC): two US/Mexico border Counties with a combined population of 824,266 and although one is an urban and rural county and the other a frontier county, they are both predominantly Hispanic (81% EPC; 79.6% HC), have a high poverty rate (26.6% EPC; 46% HC), a high proportion of uninsured (36% EPC; 54.3% HC), have low educational attainment and are medically underserved.

These factors combine ...

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Breast cancer is the leading cause of cancer among women in the US (excluding non melanotic skin cancers), is the second most common cause of cancer deaths in women overall and is the leading cancer killer among Hispanic women. Our target population resides in El Paso County (EPC) and Hudspeth County (HC): two US/Mexico border Counties with a combined population of 824,266 and although one is an urban and rural county and the other a frontier county, they are both predominantly Hispanic (81% EPC; 79.6% HC), have a high poverty rate (26.6% EPC; 46% HC), a high proportion of uninsured (36% EPC; 54.3% HC), have low educational attainment and are medically underserved.

These factors combine to have a significant impact on the burden of breast cancer. Mammography uptake is lower, rates of late stage diagnosis are higher and mortality is higher in these Border Counties compared to the rest of the US. Through an analysis of local data, key informant interviews and focus groups, we have identified key barriers to screening including a lack of knowledge, erroneous beliefs, cultural barriers, and lack of access to screening and diagnostic services.

 

The El Paso and Hudspeth County Breast Cancer Education, Screening and NavigaTion Program (BEST) is a multicomponent evidence-based program designed to reduce the breast cancer burden among uninsured women in two Border Counties. BEST is a community wide partnership led by Texas Tech University Health Sciences Center (TTUHSC), Paul L Foster School of Medicine, El Paso, in collaboration with Texas A&M Western Region Colonias program, two federally qualified health center systems (Project Vida, and Centro de Salud Familiar La Fe, Inc), the El Paso County public hospital and clinic system (University Medical Center), TTUHSC Family and Community Medicine Center, TTUHSC community partnership clinics, Southwest X-Ray, Desert Imaging, the University of Texas School of Public Health- Houston campus, local faith-based organizations, El Paso Public Housing Authority, the El Paso County Senior Centers, the YMCA , the Susan G Komen Foundation, the American Cancer Society, Rio Grande Cancer Foundation, the Public Health Department and the State 2-1-1 program.

Key program components are: 1) Community education by bilingual, certified promotoras delivering theory-based and culturally tailored group breast cancer education; 2) Outreach through targeted media and a network of geographically dispersed community partners serving El Paso and Hudspeth Counties; 3) Provision of no-cost mammography and diagnostic testing to eligible women; 4) Creation of an enhanced access mammography network for program participants; 5) Patient navigation to facilitate screening, diagnosis, health insurance coverage, access to a PCP, and treatment; 6) Implementation of tracking and reminder systems in the clinic network serving uninsured patients; 7) Creation of sustainability through development of clinical reminder and tracking systems, formation of a cohort of well informed women that understand solutions to common barriers, through incorporation of program elements into the service learning and practicum requirements for residents, medical, social worker and MPH students, and through the creation of enduring public private partnerships; and 8) A rigorous process, outcomes and cost-effectiveness evaluation.

The long term goal of BEST is to reduce the burden of breast cancer through early diagnosis and access to treatment in El Paso and Hudspeth Counties. Specific goals are: 1 )Increase community awareness and knowledge about breast cancer and mammography; 2) Reduce cultural barriers to screening, diagnosis and follow up; 3) Increase mammography rates in uninsured predominantly Hispanic women aged 40 -75 years; 4) Increase the timely uptake of diagnosis and treatment services to reduce the numbers of advanced cases; and 5) Build a sustainable screening, diagnosis and treatment network for breast cancer.

3,000 eligible women will be offered no-cost mammography screening and diagnostic follow up, navigation and education services;750 women ineligible for no cost screening will be offered education and partial navigation services and 2,000 women will be offered education and a resource list.

Innovation includes offering the full spectrum of cancer care, the creation of new public-private partnerships, targeting both community and patient populations, the tracking database, the strategies employed for achievement of sustainability, and the meticulous evaluation of the process, outcomes and cost effectiveness. This program will meet the goals of the Texas Cancer Plan which are to reduce the impact of cancer in Texas through the implementation of sustainable and effective programs that target the underserved and reduce disparities in cancer throughout the State.

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