MD Anderson Cancer Center, Integrated Mammography and Genetic Evaluation Services (IMAGES) program. Need: Texas has the highest percentage of uninsured residents in the US. The lack of health insurance deters many from seeking health care services and preventive care. In 2023, there will be an estimated 22,280 new cases of female breast cancer and approximately 3,340 deaths from breast cancer in Texas. According to the American Cancer Society, mammography rates among the uninsured continue to be half of those among the insured. Only 40 percent of uninsured women had mammograms in the past two years. Barriers to screening include the cost of screening and diagnostic services, limited access t...

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MD Anderson Cancer Center, Integrated Mammography and Genetic Evaluation Services (IMAGES) program. Need: Texas has the highest percentage of uninsured residents in the US. The lack of health insurance deters many from seeking health care services and preventive care. In 2023, there will be an estimated 22,280 new cases of female breast cancer and approximately 3,340 deaths from breast cancer in Texas. According to the American Cancer Society, mammography rates among the uninsured continue to be half of those among the insured. Only 40 percent of uninsured women had mammograms in the past two years. Barriers to screening include the cost of screening and diagnostic services, limited access to care, lack of a medical home, lack of knowledge of breast cancer risks and screening methods, immigration status, and cultural and language differences. Breast cancer is the most diagnosed cancer among women and the second most common cause of cancer death in Texas women. More breast cancer screening would reduce deaths by 26%, with 7 deaths averted for every 1,000 women screened in addition to diagnosing women with late-stage disease. Almost 98% of women diagnosed with breast cancer at the earliest stage live for at least five more years, compared to only 31% of those diagnosed at the most advanced stage. Another important factor is the contribution of hereditary factors towards breast and associated cancers. Less than 50% of individuals who are most at-risk are identified and referred for hereditary cancer genetic testing. About 15% of all breast cancers are due to pathogenic variant mutations in breast cancer-associated genes (BRCA1, BRCA2, PALB2, ATM) and increase an individual's lifetime risk of developing breast cancer significantly. Women with BRCA1/2 mutation carriers have up to a 60% lifetime risk. Studies have shown that identification of hereditary cancer carriers and appropriate interventions can reduce mortality. Many of the same barriers to screening exist for genetic testing, including a lack of awareness among healthcare providers. Strategy: To address breast cancer screening barriers, MD Anderson Cancer Center seeks CPRIT funding of $1.5 million over 3 years to expand two successful screening initiatives and merge them into one. Project VALET (PV) is the mobile mammography program for uninsured and low-income women, primarily in Harris County. PV started in 2008 and has screened 30,000+ women and identified 79 with breast cancer. Project Genetic Health (PGH) is MD Anderson's genetic evaluation program working in the community since 2018. Recently, PV and PGH initiated a pilot to provide both mammography screening and genetic evaluation services to 2 Harris County FQHCs. This has provided a model for incorporating both programs into one and is titled Integrated Mammography and Genetic Evaluation Services (IMAGES). The program will provide clinical services to 3450 patients over the 3-year grant cycle with breast and genetic education, screening mammograms, genetic evaluation, and diagnostic services for women in Fort Bend, Wharton, Matagorda, and Brazoria counties. Navigation services and other various efforts will plan on keeping the no-show rates at 20% or less. Women at high and increased risk will be referred for genetic testing and counseling and offered additional screening tests as recommended. IMAGES uses evidence-based interventions and addresses barriers such as access and cost. The program provides appropriate health education materials and on-site CHWs, all fluent in Spanish. MD Anderson has a long history of collaborating with community clinics. The new clinics requesting additional mammography services are currently participating in the CPRIT-funded Alliance for Colorectal Cancer Testing 3 initiative and are well-positioned to incorporate IMAGES into their roster of services for their patients. Significance and Impact: Through this program, IMAGES expects to expand Project VALET's current reach in 23 participating clinics, primarily in Harris County, to 3 additional rural counties, expansion within Fort Bend County and add 2 new clinic systems with multiple locations. IMAGES will provide screening, diagnostic care, and genetic evaluation to women who would not receive this level of breast health support due to cost, access and a lack of genetic evaluation in community clinics. In total, we plan on screening 3450 women over the 3-year grant period with approximately 600 women receiving free diagnostic exams. An estimated 1200 will be assessed for high or increased risk due to family history with a minimum of 200 women receiving genetic testing and counseling. The program is fully operational with four mobile mammography units. An additional 5th mobile unit is on order and will be added to the fleet in mid-2024. With this new partnership of MD Anderson's IMAGES and CPRIT, we hope to expand the safety-net systems that sustain our uninsured and low-income communities.

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