Need: Regular mammography screening remains the most effective tool to detect breast cancer early when less invasive treatments are an option and survival rates are over 98%. Unfortunately, barriers to screening and follow-up care put breast care out of reach for many women. For many, the obstacles are insurmountable and usually lead to women skipping or delaying care, often leading to adverse outcomes. Health insurance is the main reason for screening disparities and delays in care. According to the American Cancer Society's (ACS) Breast Cancer Facts and Figures 2022-2024, 36% of uninsured women under 64 reported being up to date with the mammography screening recommendations, and 44% repo...

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Need: Regular mammography screening remains the most effective tool to detect breast cancer early when less invasive treatments are an option and survival rates are over 98%. Unfortunately, barriers to screening and follow-up care put breast care out of reach for many women. For many, the obstacles are insurmountable and usually lead to women skipping or delaying care, often leading to adverse outcomes. Health insurance is the main reason for screening disparities and delays in care. According to the American Cancer Society's (ACS) Breast Cancer Facts and Figures 2022-2024, 36% of uninsured women under 64 reported being up to date with the mammography screening recommendations, and 44% reported mammography within the last two years. Screening rates for insured women are almost double at 70% and 80%, respectively. Non-medical drivers of health (Social Determinants of Health), including lack of access to care, no regular healthcare provider or provider recommendation, familial issues, work inflexibility, limited income, fear, and limited education, also negatively impact breast cancer screening. The region is home to the largest number of uninsured residents of any metropolitan area in the nation, Greater Houston, with an uninsured rate of 24%. The 45-county service area has a population of over 2 million uninsured residents and 1.4 million residents living in poverty. The area is also populated with a large number of ethnic minorities, people of color, new immigrants to the US, and rural residents - all of who experience issues with access to healthcare and have traditionally some of the lowest breast screening rates. With 9.4 million residents and a land mass the size of Indiana, the challenges to providing services are significant. The Rose seeks grant funding of $2.5 million over 24 months to support the CPRIT-funded Empower Her® to Care Project 7 (EHC7) Project. EHC7 maintains the current level of breast care and expands the service area to two additional counties, Henderson and Smith. EHC 7 will deliver breast cancer screening, diagnostic procedures, and patient navigation services to 5,200 underresourced residents in the service area. Project Strategy: The Rose employs multicomponent, evidence-based strategies and interventions as outlined in The Community Preventive Services The Community Guide. The Program focuses on three strategic categories - increasing community demand, increasing community access, and increasing provider delivery. The Program intends to serve 5,200 clients through screening, diagnostic services, and patient navigation, including 2,800 through the Mobile Mammography Program. The Rose will assign Community Engagement Navigators (CENs) to engage the community and clinical partners to schedule outreach and education activities and mobile mammography events. The CENs will also navigate patients into screening and diagnostic care and follow the patient to resolve their clinical process. The EHC7 also removes the financial barrier to screening and breast care and ensures women comply with recommended screening or follow-up care. Uninsured women who meet program eligibility guidelines will have no out-of-pocket cost. EHC7 will utilize the mobile mammography program to remove transportation and access issues for women in the service area. The Rose will leverage the Mobile Mammography Program, the Community Engagement and Patient Navigation Teams, and the Emower Her® to Care Program to address the multiple barriers for women in geographically isolated urban and rural communities. Goals: EHC7 will maintain breast care in the 43-county service area and expand to Smith and Henderson Counties. The Project also aims to increase access to breast screening by increasing the number of mobile mammography events/days in the service area. Ensuring continuity of care, EHC 7 will provide 100% of abnormal screening patients are navigated to follow-up diagnostic services at one of The Rose's two diagnostic centers. Any uninsured patient diagnosed with breast cancer will be navigated to a treatment program where they are eligible for a timely start to treatment. Significance and Impact: With the EHC7, The Rose will provide screening and follow-up diagnostic care to underresourced women with limited breast care services. The Project impacts at the community, organization, and individual levels. Working in collaboration with community-based clinics, the Project extends the services provided by the clinic with onsite mobile mammography screening services. The partnership establishes a consistent community presence that fills the current gap in breast screening services in rural and geographically isolated urban areas. With breast screening services, timely follow-up care, access to timely treatment, and the funded EHC7 Project, The Rose changes systems and improves the safety nets that support vulnerable and underresourced Southeast Texas residents.

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