Need:Rural Texas counties have a greater cancer burden than their urban counterparts due to access-to-care barriers (being uninsured, poor and with limited transportation) and lack of infrastructure to carry out prevention programs. With more than 80% of Texas designated rural by federal government standards, 3.3 million people live in rural communities. Moreover, most uninsured Texan adults are low-income workers: nearly 70% of uninsured adults are in a working family, and 40% live below the poverty level. Despite healthcare reform, Texas still has the highest number of uninsured, non-elderly adults in the nation at just over 20%. Rural Texas women are more likely to have breast cancers dia...

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Need:Rural Texas counties have a greater cancer burden than their urban counterparts due to access-to-care barriers (being uninsured, poor and with limited transportation) and lack of infrastructure to carry out prevention programs. With more than 80% of Texas designated rural by federal government standards, 3.3 million people live in rural communities. Moreover, most uninsured Texan adults are low-income workers: nearly 70% of uninsured adults are in a working family, and 40% live below the poverty level. Despite healthcare reform, Texas still has the highest number of uninsured, non-elderly adults in the nation at just over 20%. Rural Texas women are more likely to have breast cancers diagnosed at a later, more invasive stage thus reflecting higher breast cancer mortality rates. According to the Texas Cancer Registry, breast cancer mortality rates for women are higher than the Texas’ rate of 20.5 per 100,000 in 19 of the 41 targeted counties (ranging from 34.9–21.3 age-adjusted rate per 100,000). The Rose seeks renewal grant funding in the amount of $1,999,952 over 24 months to support the successful progress and expansion of the CPRIT-funded Empower Her® to Care project. This Project (the Empower Her to Care - EHC4) will increase the delivery of breast cancer screening, diagnostic procedures and patient navigation services to 3,275 underserved women in the existing 38 targeted counties while expanding to three new Texas counties. Overall Project Strategy:The two-year project will serve 3,275 underserved/uninsured women, age 40 and above, targeting women who have never been screened or are not regularly receiving annual mammograms and live within 41 Texas counties. The Empower Her to Care program's current service area includes Austin, Brazoria, Burleson, Chambers, Cherokee, Colorado, Fort Bend, Galveston, Hardin, Harris, Houston, Jasper, Jefferson, Liberty, Matagorda, Montgomery, Newton, Panola, Polk, Rusk, Sabine, San Augustine, San Jacinto, Shelby, Tyler, Waller, Washington, Wharton, Angelina, Brazos, Trinity, Walker, Leon, Robertson, Madison, Orange, Grimes, and Nacogdoches counties. The new Empower Her to Care Expansion (EHC5) will add three counties (Anderson, Fayette and Lee) that are currently not well served by the CPRIT portfolio under preventive care. Services will be provided through The Rose’s digital Mobile Mammography Program and through partnerships with established community clinics, physicians and other organizations that offer education/outreach efforts and help to recruit eligible patients who need screening or diagnostic care. Diagnostic testing, coordinated care and access to breast cancer treatment will be provided at either of The Rose’s two locations in Houston or by way of collaborative health systems such as Houston Methodist and Harris Health all located in the Texas Medical Center or at satellite community systems. By addressing transportation, financial and system barriers, the EHC5 project will increase access to breast cancer screening and follow-up diagnostic services-a continuum of care unique to medically underserved and rural communities. To address barriers, The Rose will apply the following evidenced-based models to promote cancer prevention and control: 1) reduce structural barriers through mobile mammography, 2) reduce and/or eliminate out-of-pocket costs for services and transportation (CPRIT-funded care), 3) apply client reminders for appointments; 4) reduce structural barriers through patient navigation services to ensure timely access to diagnostic testing and breast cancer treatment. Specific Goals:The EHC5 expansion project will serve 3,275 unique clients (Y1=1,600 and Y2=1675) over 24 months needing access to mammography screenings, diagnostic follow-up, coordinated care and access to treatment with the overall goal of reducing breast cancer mortality in Texas. Breast cancer screening guidelines comply with the current national guidelines of the Health Resources & Services Administration (HRSA), American Congress of Obstetricians and Gynecologists (ACOG), National Comprehensive Cancer Network, the American College of Radiology (ACR) and Society of Breast Imaging (SBI) recommending that annual mammography screening, beginning at age 40, saves the most lives. Significance and Impact:With CPRIT partnership, the EHC5 project will help to increase breast cancer screening awareness, promote the availability of CPRIT program funding to increase access to care, deliver services and coordinated care, and strengthen safety-net systems. Since implemented in 2010, the original CPRIT Empower Her to Care (EHC1) grant has served 16,005 Texas women over 105 months. Of those served, 336 breast cancers were detected and 128(38%) of those cancers were detected through first-ever mammograms. The CPRIT-funded Empower Her to Care grant is making a significant impact in Texas, saving lives and improving safety-net systems that will sustain care for generations.

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