Introduction

Women in underserved rural/border communities in West & South Texas have critical barriers to cervical cancer screening, specifically uninsured populations. Hispanic women and women in rural areas have a higher cervical cancer incidence, are diagnosed at later stages and suffer disproportionate cervical cancer mortality compared to their counterparts. We have designed a program that addresses the needs of the community and gaps in services, comprised of education, outreach, service delivery, navigation, and capacity building.

Methods

The De Casa en Casa is a multi-component evidence-based, culturally-tailored, and bilingual and theory-based program to areas in West and South Texas initially funded by CPRIT in 2014, serving two counties. Since then, De Casa has expanded to target 16 screening delivery sites within a 61-county service area. Key program components include: 1) theory-based and culturally tailored cervical cancer education; 2) provision of no-cost pap and HPV screening for women aged 21-65 who are uninsured/underinsured, have self-reported Texas address, and are due for screening; 3) on-site diagnostic/treatment colposcopy; 4) patient navigation/tracking to facilitate screening, diagnosis, health insurance coverage, access to a PCP and treatment; 5) and enhanced resident/faculty colposcopy training to increase capacity.

Results

To date, 11,044 women have been recruited into the program; 7,137 have completed screening [64.6%] and 537 completed a colposcopy. Over 1,300 first-time screeners have received service and 12 cancers have been diagnosed and navigated into treatment.

De Casa 3 has currently enrolled over  2,812 women, all educated and screening eligible: mean age 46.9 years. 35.1% had never had a pap smear or last received one in over five years. Screening uptake is 69.2% (n=1946) and 7.2% (n=142) required a colposcopy (84.5% completion rate). 8.9% were positive for high risk HPV and 3 cancers have been diagnosed. The program has reached 59 West & South Texas counties, providing services to 1,927 women, 93 women who were referred to a colposcopy (4.8%), and 48 [51.6%] completed a colposcopy.

Conclusion

De Casa has been successful in receiving funding for the past eight years and has increased screening rates in communities, along with knowledge, and helped to improve attitudes and beliefs about cervical cancer. The program has significantly impacted cervical cancer prevention, expanding an effective program to individuals in over 20% of all Texas counties, helping to reduce the impact of cancer in Texas.