In North Texas, rural and underserved counties comprise the majority of Health Service Region (HSR) 3 and portions of HSR 2 and HSR 7. Covering 14,500 square miles, twice the size of New Jersey, the area reported one of the highest breast cancer incidence rates in Texas, yet one-third of these women were not adherent to guideline-based screening due to lack of financial access and inadequate rural public health infrastructure.

Low-income and uninsured women residing in these counties also represent those at greatest risk for decreased access to routine preventive care. 15.4% of the area population reported living below the Federal Poverty Level; nearly 21% were uninsured and 26.5% were...

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In North Texas, rural and underserved counties comprise the majority of Health Service Region (HSR) 3 and portions of HSR 2 and HSR 7. Covering 14,500 square miles, twice the size of New Jersey, the area reported one of the highest breast cancer incidence rates in Texas, yet one-third of these women were not adherent to guideline-based screening due to lack of financial access and inadequate rural public health infrastructure.

Low-income and uninsured women residing in these counties also represent those at greatest risk for decreased access to routine preventive care. 15.4% of the area population reported living below the Federal Poverty Level; nearly 21% were uninsured and 26.5% were either underinsured or enrolled in Medicaid. Despite state and national changes in healthcare access that continue to impact the delivery of care across North Texas, demand for breast cancer screening services continues to outpace local provider capacity.

Through our initial project, nearly 40% of BSPAN2 patients have not had a mammogram in 10 years; 88% of women served are uninsured; >60% are racial and ethnic minorities while 90% report <200% federal poverty level. In two years, we identified more than 280 cancers, 75% of which were early stage (0,I,II) compared to the state average of 60%. Our program sustains a critical cancer prevention network for community-based care, linking under- and uninsured women to local providers, none of whom would be capable of providing these clinical services without access to the BCCS reimbursement that our BSPAN network facilitates.

With CPRIT support, the Breast Screening and Patient Navigation (BSPAN2) program successfully expanded comprehensive mammography and appropriate follow-up services from five to seventeen underserved, rural North Texas counties. Through Moncrief Cancer Institute’s model of oncology-certified nurse-driven clinical navigation, our initial project was able to maintain key quality metrics throughout this expansion. Even as the BSPAN2 program more than tripled in both size (number of women served) and scope (number of counties) over the project period, we provided timely mammography services to more than 14,500 unique women. As a contractor for the Texas Breast & Cervical Cancer Services (BCCS), BSPAN2 leveraged state and federal funds to provide culturally sensitive services in collaboration with local community partners (e.g., physician practices, community clinics and hospitals, churches, non-profit organizations) across the region.

We assessed each rural county’s capacity to collaborate with BSPAN2, identified key partners and tailored the BSPAN program in each county to provide 1) Outreach & Health Promotion to reach underserved women, 2) oncology-certified nurse-driven Delivery & Navigation to guide patients through screening and appropriate follow-up, while serving as the source of 3) Centralized Reimbursement to fund mammography services through our Texas BCCS contract to participating local providers.

In this competitive renewal, our specific goals are to: 1. Address persistent need by further expanding BSPAN3 service into Ellis, Navarro, and Grayson Counties over Year 1, while continuing to provide care to under- and uninsured women across the initial 17-county rural and underserved service area (N=21 counties). We will reach approximately 187,000 screen-eligible women and will serve over 14,000 patients with oncology-certified nurse-driven clinical navigation, screening and appropriate follow-up. With CPRIT funds, BSPAN3 will provide at least: 1500 screening mammograms, 700 diagnostic mammograms, and 138 biopsies. 2. Increase the number of community partners collaborating in each of the 21 counties to strengthen rural outreach and enhance program visibility for vulnerable women and our participating providers. In response to unexpectedly higher demand in the initial project, BSPAN3 outreach will place particular emphasis on meeting the needs of underserved Hispanic women in these rural communities. 3. Improve screening access by sustaining key quality metrics, increasing timely clinical resolution and facilitating referral to local treatment services as needed.

With CPRIT support, we have marshaled county leadership, infrastructure and local resources since 2009 to mobilize rural communities across North Texas to increase access to high-quality breast cancer screening and patient navigation for women who would otherwise not receive guideline-based care. For most, lack of access to a local provider means going without care entirely. In the initial project, we successfully connected over 15,000 women across 17 counties to receive comprehensive screening and patient navigation services and returned more than $1.4 million in Texas BCCS funds to a network of >40 local partners across North Texas, leveraging an additional $750,000 in community and philanthropic sources.

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