This application proposes to continue breast and 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 and mortality is higher than state average at 20.9, and 23.8 per 100,000 respectively. Cervical cancer incidence is higher than state average at 11.0, while mortality is lower at 2.5 per 100,000. This is results from lack of access to screening/early detection for the largely underserved population. The HPV vaccination coverage in COG-1 is less...

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This application proposes to continue breast and 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 and mortality is higher than state average at 20.9, and 23.8 per 100,000 respectively. Cervical cancer incidence is higher than state average at 11.0, while mortality is lower at 2.5 per 100,000. This results from lack of access to screening/early detection for the largely underserved population. The HPV vaccination coverage in COG-1 is less than 14 for at least one dose compared to Texas average of 18 (national average = 53). This results from socioeconomic, educational, cultural and geographical barriers impeding access to healthcare.

ABC24WT network s strategic public-private-community partnerships continue to overcome these barriers and have provided almost 7,000 services for breast and cervical cancer screening/prevention and 89 services for treatment of cancers/high-risk lesions. ABC24WT proposes a continuation project to consolidate teams/processes for women's' cancer prevention and create sustainable systems change for comprehensive women's healthcare to include breast and cervical screening/vaccination. We will target the uninsured/underinsured population of COG-1 for education, awareness, screening and prevention.

The overarching strategy for screening/prevention is a unique model of public-private-community partnership created by the ABC24WT project. This model utilizes the evidence-based approaches of Train the Trainer model, culturally sensitive educational materials, community activists, and the precede-proceed model. Innovative strategies will be added to enhance HPV vaccination such as post-partum clinic targets, college student education, and inclusion with other adolescent vaccination etc.

Specifically, ABC24WT will target women and their families via an educational/awareness campaign. County focused events will partner with local providers and target the women 40 and older for screening mammograms, 21 and older for screening Pap smears, and children 9-26 for HPV vaccination. Mobile clinics will be used for on-the spot services. 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, uninsured, and rural population are the primary target. The no cost services will be provided to uninsured/underinsured population who do not qualify for other indigent care funds.

The ultimate goal is to reduce the human and economic burden of breast and cervical cancer in COG-1. Measurable interim goals include (i)increasing the rate of breast cancer screening, (ii)increasing the rate of cervical cancer screening, and (iii)increasing the rate of vaccination against HPV. We project to reach 200,000 people via non-interactive educational and outreach activities and 25,000 people via direct educational activities/services. County specific trends will be tracked to re-direct efforts at the most needy counties.

ABC24WT provides significant scaffolding for the public-private-community partnership model. This model was first established for breast cancer screening/prevention, and then scaled to cervical cancer services (scaled for new service). The impact is evident by the drop in advanced breast cancer rate from 20 to 5 in the target community; and over 100% increase in HPV vaccination. Another example of scalability is the replication at the San Angelo project, funded by CPRIT (scaled for new geographical location).

The proposed continuation 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 the uninsured/underinsured population. Since early disease is curable, these women are likely to remain productive members of society. Many women served by ABC24WT 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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