Along with vaccination against human papillomavirus (HPV), screening, early detection, and treatment of cervical precancer is an effective intervention for preventing cervical cancer. In Texas and the United States (U.S.) and other high-income countries with organized screening programs, cervical cancer incidence and mortality declined dramatically in the initial decades following the widespread implementation of cytology- (i.e., Papanicolaou smear) based screening. However, cervical cancer mortality in Texas and the U.S. has plateaued over the past two decades and there is growing evidence that cervical cancer incidence is rising in medically underserved populations. At the same time, ...

Read More

Along with vaccination against human papillomavirus (HPV), screening, early detection, and treatment of cervical precancer is an effective intervention for preventing cervical cancer. In Texas and the United States (U.S.) and other high-income countries with organized screening programs, cervical cancer incidence and mortality declined dramatically in the initial decades following the widespread implementation of cytology- (i.e., Papanicolaou smear) based screening. However, cervical cancer mortality in Texas and the U.S. has plateaued over the past two decades and there is growing evidence that cervical cancer incidence is rising in medically underserved populations. At the same time, cervical cancer screening has steadily declined over the past 20 years. Screening is the most effective strategy for preventing cervical cancer in the current generation. Implementation of second-generation screening with primary testing for high-risk HPV (HR-HPV) offers an opportunity to improve screening outcomes and reach persons for whom cytology-based screening is inaccessible and/or unacceptable due to its ability to be performed by minimally trained lay persons and by individuals themselves through self-sampling. In fact, primary HR-HPV testing with self-sampling, which has been implemented in numerous countries worldwide, is associated with an over two-fold increase in screening participation among underscreened persons compared to provider-performed screening. In 2020 American Cancer Society screening guidelines recommend primary HR-HPV testing as the preferred test for cervical cancer screening. In the Fall of 2023, the U.S. Food and Drug Administration (FDA) is expected to approve self-sampling for HR-HPV testing. These developments will lead to a paradigm shift for how cervical cancer screening is performed in the U.S., as has already occurred in multiple other high- and low-income countries. It crucial that Texas health systems prepare for this paradigm shift, particularly safety net health systems that care for the underserved populations that are disproportionately affected by cervical cancer. Overall Project Strategy The overarching goal of the proposed program is to increase cervical cancer screening, early detection, and linkage to treatment in underserved populations that receive care in safety net health systems. To accomplish this goal, we have formed a private-public partnership between two safety net health systems (Harris Health System in Harris County and Su Clinica in the Rio Grande Valley), academic institutions, an industry partner, and the American Cancer Society National Roundtable for Cervical Cancer Screening (ACS NRCCS) to pioneer the implementation of primary HR-HPV testing with self-sampling in Texas and the U.S. Drawing on the successes of our past and current CPRIT-funded cervical cancer screening programs, we will implement a comprehensive program to address barriers along the screening continuum of care. The pillars of our program include: 1) health system changes guided by the ACS NRCCS Implementation Roadmap; 2) provider training and practice facilitation; 3) patient education; 4) patient navigation; and 5) capacity building using Project ECHO® (Extension for Community Healthcare Outcomes) and our existing ECHO Network. Specific Goals Goal 1. To increase up-to-date cervical cancer screening coverage in partner health systems by 10%; 2) To increase clinical encounters used for opportunistic cervical cancer screening using primary HR-HPV testing by 5% annually; 3) To increase awareness and readiness for implementing primary HR-HPV testing with self-sampling in routine care among clinics in the ECHO Network; 4) All patients with abnormal screening results will be navigated to and receive diagnostic testing. All patients diagnosed with cancer that require treatment will be navigated into treatment. Through our collaborative program, we will provide an estimated 34,595 clinical, education and navigation services for 32,700 persons. Statewide, we anticipate over 470,000 individuals (public and professional) will be reached by our program. Significance and Impact In implementing the proposed program, we will develop an effective and sustainable model for the integration of primary HR-HPV testing with self-sampling in clinical practice that will inform the development of an implementation blueprint for Texas and U.S. health systems. Through our partnerships with two strategic safety net health systems in Texas we will ensure that the ensuing implementation blueprint is reflective of the context of limited-resource healthcare setting so that other safety net health systems are readily able to implement similar programs to increase screening participation and reduce the burden of cervical cancer in their catchment areas. At the same time, we will dramatically improve coverage of up-to-date cervical cancer screening and follow-up care in our partner health systems.

Read Less