Despite effective tools for its prevention, cervical cancer remains a significant public health issue for Houston and Harris County. For the period 2007-2011, age-adjusted rates of cervical cancer in Harris County (10.8/100,000) were significantly higher than than most other parts of Texas
(mean = 9.4/100,000) as well as the United States (7.8/100,000). Rates of cervical cancer remain particularly high among Hispanic women in Harris County (15.0/100,000) when compared to other demographic groups (10.7 per 100,000 for non-Hispanic whites, 2006-2010).

Certainly, one factor contributing to the disproportionate burden of this disease in the Houston metroplex is the large proportion of indi...

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Despite effective tools for its prevention, cervical cancer remains a significant public health issue for Houston and Harris County. For the period 2007-2011, age-adjusted rates of cervical cancer in Harris County (10.8/100,000) were significantly higher than than most other parts of Texas
(mean = 9.4/100,000) as well as the United States (7.8/100,000). Rates of cervical cancer remain particularly high among Hispanic women in Harris County (15.0/100,000) when compared to other demographic groups (10.7 per 100,000 for non-Hispanic whites, 2006-2010).

Certainly, one factor contributing to the disproportionate burden of this disease in the Houston metroplex is the large proportion of individuals (31.7%) who lack sufficient insurance to regularly obtain preventive health services, such as the Pap test. Innovative strategies are urgently needed to address these unfortunate disparities.

We recently developed a comprehensive cervical cancer screening program with the long-term goal of reducing the incidence of cervical cancer and eliminating key cancer disparities, such as the excess burden of this disease found among Hispanic women. Key elements contributing to the success of our program have been the use of medical homes for screening and a highly effective system for patient navigation to insure that women with abnormal screening outcomes are not lost to evaluation and treatment. We intend to build upon this robust platform, leveraging efficiencies gained during its development to further expand its scope, support sustainability and engage specific at risk populations.

The proposed work has been carefully designed to a) enhance the medical homes developed as part of PP120091 to increase numbers of medically underserved Harris County women screened for cervical cancer and b) further improve access of high risk populations of women to colposcopy services at Harris Health System (HHS) community health clinics.

Medical homes developed as part of our initial project will be re-organized to improve both patient continuity and access so that an additional 9,000 women can be screened during the next three years. Capacity at medical homes will also be grown so that increased numbers of medically undeserved women with abnormal cervical cytology (n=3,135) can undergo colposcopy.

A key element in this proposal will be the expansion of our highly successful navigation efforts to improve and streamline the referral of women diagnosed with cytology at sites external to the Harris Health System. This objective addresses a new area of need identified since the submission of our initial CPRIT-funded proposal. Of note, the focus of our navigation platform will be expanded with engaging the large population of Hispanic and African American women who have never been previously screened for cervical cancer despite the fact that they are actively receiving other types of primary care at an HHS facility. Over three years, we anticipate that our streamlined navigation system will be used to navigate more than 13,500 women to timely screening and/or follow up.

Lastly, guidelines will be developed to address areas of ambiguity in current ASCCP recommendations for the evaluation of abnormal cervical cytology with the goal of enhancing the timeliness and efficiency of colposcopic services provided, decrease the proportion of colposcopies cancelled by providers after patients have scheduled and minimize patient confusion and frustration. As part of these efforts, 240 professionals will be educated regarding current national guidelines for cervical cancer screening.

The efficient and timely delivery of the services provided by our program plays a unique role in the Harris County community, insuring that thousands of women have been properly treated before they develop cancer. Due to the large numbers of medically underserved Hispanic and African-American women served by the Harris Health System, the primary clinical venue for our program and its expansion provides an ideal platform to target disparities impacting these at-risk communities.

Our approach to patient navigation is unique in terms of its comprehensive approach. We believe that its comprehensive nature will prove helpful as we seek to utilize this platform to engage women who have never previously been screened. Lessons learned from project implementation will continue to impact ongoing patterns of care at HHS and durably outlast receipt of CPRIT support in a manner that can be readily scaled and applied throughout Texas and the United States.

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