Texas Cancer Registry data show that for the years 2015-2019, Harris County had a similar overall incidence of BC (113.4 per 100,000) compared to Texas. The BC incidence in Harris County was higher for both NH-Whites and NH-Blacks (130.4 per 100,000; 123.7 per 100,000, respectively) compared to Texas for both groups (130.1 per 100,000 for NH-Whites in Texas vs. 123.6 per 100,000 for all NH-Blacks in Texas). The incidence of invasive BC in Polk County is alarmingly high, with an age-adjusted rate of 157.5 per 100,000, surpassing the state's average of 117.0 per 100,000. Furthermore, the racial/ethnic breakdown of incidence rates is particularly striking, with non-Hispanic Blacks experie...

Read More

Texas Cancer Registry data show that for the years 2015-2019, Harris County had a similar overall incidence of BC (113.4 per 100,000) compared to Texas. The BC incidence in Harris County was higher for both NH-Whites and NH-Blacks (130.4 per 100,000; 123.7 per 100,000, respectively) compared to Texas for both groups (130.1 per 100,000 for NH-Whites in Texas vs. 123.6 per 100,000 for all NH-Blacks in Texas). The incidence of invasive BC in Polk County is alarmingly high, with an age-adjusted rate of 157.5 per 100,000, surpassing the state's average of 117.0 per 100,000. Furthermore, the racial/ethnic breakdown of incidence rates is particularly striking, with non-Hispanic Blacks experiencing a substantially higher rate of 187.3 per 100,000, compared to non-Hispanic whites at 157.2 per 100,000. The disparities extend to mortality rates as well, with the overall mortality rate in Polk County being 22.6 per 100,000, which is notably higher than the state's average of 19.8 per 100,000. Although the BC incidence for African American women in Harris County is lower compared to Non-Hispanic White women, BC mortality is disproportionately higher for African American women (31.1 per 100,000 for blacks versus 22.2 per 100,000 for whites). This is higher than the goal of 20.7 per 100,000 that the CDC and NIH have stipulated in the Healthy People 2020 objectives. The precise cause behind the observed disparity in breast cancer (BC) mortality among African American women remains unclear. Several factors might contribute to this disparity, including potential delays in diagnosis resulting from a lack of insurance coverage, cultural beliefs that foster denial about cancer, limited access to higher quality cancer care, and delays in initiating timely medical treatment. Furthermore, biological factors could play a role, as studies (ref 11 and 12) suggest that African American women may present with more aggressive tumors, leading to earlier and distant spread of BC, ultimately contributing to a higher risk of death. Overall Project Strategy: Our approach to increasing timely BC screening and follow-up for the diverse patient populations of Baylor College of Medicine (BCM), and CHI St. Luke, will include several strategies: 1) Harnessing key features of the EHR to better coordinate patient navigation and follow-up of age-eligible patients who are to receive BC screening and those at high risk for developing BC; 2) Implementing a PN workbench to facilitate identification of gaps in care and integrate care management/coordination to help providers achieve patient cancer screening goals and potentially maximize the likelihood of sustainability beyond the funding period; 3) Providing interactive and culturally/linguistically appropriate PN-led BC outreach and education, and encourage adoption of healthy lifestyle BC risk reduction behaviors; 4) Leveraging of existing culturally/linguistically appropriate multi-media BC education resources, including BC monologues, and point of care BC videos, and other BC educational materials available on BCM's web page (all of which will be installed or made available to CHI St. Luke). Specific Goals: 1) Provide outreach and education regarding BC and CRC prevention and screening guidelines and services for age-eligible community residents served by BCM and CHI St. Luke; 2) Implement a patient navigator-led BC navigation workbench integrated into the CHI St. Luke EHR to document the completion and follow-up of BC screening services; 3) Continue patient navigator-led CRC care navigation at BCM and CHI St. Luke to increase access to CRC screening services; 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. Significance and Impact: After a review of the BC screening workflow at BCM and CHI St Luke, we identified distinct gaps and inefficiencies in the referral process, scheduling, and follow-up for eligible patients. At BCM, over a one-year period, a total of 9,896 women had a screening mammogram order, and 2,297 had a diagnostic mammogram order placed in the EHR. Of the 9,896 screening mammogram orders, 5,615 completed a screening mammogram (56.7%). Of the 2,297 diagnostic mammogram orders, 1,279 completed a diagnostic mammogram (55.6%). However, during the same period, 5,299 age-eligible women with BC screening orders (43.3%) in the EHR have yet to be scheduled for BC screening (4,281 screening, 1,018 diagnostic mammograms). A review of the rural patient population serviced by CHI St. Luke revealed that the total estimated population eligible for BC screening (age 40-75) for Polk County is 3,069 in 2022. Out of these individuals, only 774 completed BC screenings.

Read Less