Addressing cervical cancer disparities in Texas: Expansion of a community-based prevention initiative for medically underserved populations
Introduction
Although cervical cancer is a preventable disease, differential incidence and cancer-specific mortality across different geographical areas of the United States (US) highlight the health care disparities that exist in access to screening and prevention services. In certain medically underserved areas (MUAs) of Texas, such as the Rio Grande Valley (RGV) along the Texas-Mexico border, these rates are 55% higher compared to the remainder of the U.S. The U.S. Preventive Services Task Force recommends multicomponent interventions to increase cervical cancer screening, as these have been shown to increase screening through addressing barriers to screening in women living in MUAs. In addition, using patient navigation in comprehensive programs is also a promising approach to improving cervical cancer prevention. Our goal was to implement a multicomponent program in clinics located in MUAs of Texas to increase cervical cancer screening, early detection, and treatment of women with preinvasive disease.
Methods
In 2019, we implemented a multicomponent, comprehensive program to improve cervical cancer prevention in partnership with 13 clinics and mobile vans in MUAs of Texas. Our multicomponent intervention program consists of community education and patient navigation coupled with a training/mentoring program for local medical providers to perform diagnostic procedures and treatment for patients with abnormal screening results. The community education and patient navigation are performed by navigators hired, trained and supported through the program. Hands-on training courses are held for local doctors, nurse practitioners and physician assistants to learn colposcopy and loop electrosurgical excision procedure (LEEP). These trainings are coupled with biweekly telementoring conferences using Project ECHO® (Extension for Community Healthcare Outcomes) for continuing education through didactic lectures and case discussions. This program was initially implemented in the RGV in 2015 and expanded to other MUAs in Texas including Laredo, Northeast Texas, Bastrop, and Brazoria counties in 2019. Our aim is to evaluate the impact of the expansion program. We assessed the number of community members educated, as well as the number of patients who underwent cervical cancer screening, diagnosis, and/or treatment as part of our program implementation.
Results
From March 2019 to August 2022, 75,842 individuals were educated about cervical cancer screening and HPV vaccination. A total of 44,781 women underwent screening for cervical cancer, 2,216 underwent colposcopy and 264 underwent LEEP. High-grade cervical dysplasia was diagnosed in 658 individuals and invasive cervical cancer in 33 individuals. We trained 22 providers to perform colposcopy and/or LEEP, approximately doubling the number of local providers experienced in these procedures. In addition, 78 Project ECHO telementoring sessions were held with an average of 42 attendees per session, with 72 individual patient cases discussed. We also held four in-person hands-on training courses (two in-person and two virtual due to the COVID-19 pandemic).
Conclusion
Our comprehensive community-based prevention initiative for medically underserved populations has led to a significant number of individuals undergoing cervical cancer screening in MUAs, as well as improved access to colposcopy and LEEP services through patient navigation and increased number of medical providers trained to perform these procedures.