Need Colorectal (CRC) and cervical cancer (CxC) remain significant causes of morbidity and mortality in Texas, the U.S. and worldwide. In Harris County, Texas, CRC is the second leading cause of cancer-related mortality for men and women combined and CxC incidence is significantly higher than nationally. Both cancers are marked by stark racial/ethnic disparities. For example, in Harris County, the burden of CxC is almost twice as high among Hispanic compared to non-Hispanic white women. CRC is significantly higher among Black men and women compared to non-Hispanic whites. There are effective screening tools for the early detection of CRC and CxC. However, screening rates are sub-optimal, par...

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Need Colorectal (CRC) and cervical cancer (CxC) remain significant causes of morbidity and mortality in Texas, the U.S. and worldwide. In Harris County, Texas, CRC is the second leading cause of cancer-related mortality for men and women combined and CxC incidence is significantly higher than nationally. Both cancers are marked by stark racial/ethnic disparities. For example, in Harris County, the burden of CxC is almost twice as high among Hispanic compared to non-Hispanic white women. CRC is significantly higher among Black men and women compared to non-Hispanic whites. There are effective screening tools for the early detection of CRC and CxC. However, screening rates are sub-optimal, particularly among racial/ethnic minorities. For example, in 2018 only 80% of Texas Hispanic women reported having a recent CxC screening test compared to 93.3% of non-Hispanic white women. Inadequate access is one of the major barriers for CRC and CxC screening. This is a major barrier in Harris County, which has a population of over 4.7 million and one of the highest uninsured rates in the nation (22.6% vs. 8% nationally). The ongoing COVID-19 pandemic and policies to curtail its spread have had a dramatic impact on cancer screening. In the early stages of the pandemic, CRC and CxC screening decreased by 70 to 90%. Since then, cancer screening has increased, but is still at substantially lower levels than pre-pandemic. This raises concerns that COVID-19-related screening delays will lead to excess late-stage CRC and CxC diagnoses and deaths. As health systems resume primary and preventive care visits, it is likely that several COVID-19-related challenges will slow the return of cancer screening to pre-pandemic levels. Medically underserved racial/ethnic minority populations that are most vulnerable to instability and insecurity are likely to be disproportionately affected. Overall Project Strategy In 2010, we established the Community Network for Cancer Prevention (CNCP), an academic-community partnership to empower medically underserved Harris County residents to seek and obtain cancer prevention, screening, and follow-up services. The network includes Harris Health System, the county’s safety-net system and the third largest safety net health system in the U.S., and other safety net providers: San Jose Clinic, Tomagwa Healthcare Ministries, Hope Clinic, and Harris County Public Health. With almost a decade of CPRIT prevention service funding, we dramatically improved CRC and CxC screening rates over baseline. Furthermore, we achieved profound decreases in loss-to-follow-up among screen-positive patients. Nonetheless, we are acutely aware of the challenges of sustaining comprehensive CRC and CxC control programs in safety net health systems with low resources. The proposed maintenance expansion program will address critical gaps in our program that have hindered screening from achieving its full potential. It will also strengthen the capacity of safety net health systems and clinics to implement population-based CRC and CxC screening. Broad programmatic strategies are to 1) implement health system changes to increase capacity and expand access to screening, eliminate missed opportunities, and ensure follow-up through the cancer continuum of care; and to 2) adapt and implement community-based strategies to promote CRC and CxC screening among medically underserved residents. Specific new components include implementing a mailed home-based fecal immunochemical test (FIT) program for CRC screening, using patient education videos to increase access to telehealth, and expanding outreach to the Vietnamese community, among others. Specific Goals The overarching goal of the maintenance expansion program is to strengthen safety net health system’s capacity to provide CRC and CxC screening and follow-up to medically underserved, racial/ethnic minorities. Our specific goals are to: 1) Increase the proportion of adult patients ages 50-75 years who are screened for CRC and receive appropriate follow-up 2) Increase the proportion of female patients ages 21-64 years who are screened for CxC and receive appropriate follow-up. 3) Increase awareness and intention to screen among medically underserved racial/ethnic minority residents Significance and Impact The proposed program will significantly increase the number and proportion of medically underserved racial/ethnic minority adults who are screened for CRC and CxC. It will also ensure the attainment of the Healthy People 2030 CRC and CxC screening goals of 74.4% and 84.3%, respectively, at Harris Health System, the nation’s third largest safety net health system. Finally it will strengthen the capacity of community clinics to screen their medically underserved patients. These efforts contribute directly to CPRIT’s goals to reduce deaths and the number of new cases of CRC and CxC through screening and early detection.

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