Collaborative efforts led by the Dan L Duncan Cancer Center at Baylor College of Medicine to improve screening and follow-up of abnormal test results for colorectal and cervical cancer among the medically underserved have had a significant impact in Harris County over the last three years, and now a new project is underway that is expected to bring about similar improvements to breast cancer screening. 

“Poor screening rates coupled with a lack of continued care among patients who did receive screening contributed to disproportionately high rates of colorectal and cervical cancer among Harris County’s medically underserved population,” said Dr. Maria Jibaja-Weiss, director of the Duncan Cancer Center’s Office of Outreach and Health Disparities. “We took a systematic approach to improving screening and follow-up of abnormal results that has led to dramatic improvements, and we’re looking forward to now expanding these efforts to breast cancer screening and care.”   

The Duncan Cancer Center created the Office of Outreach and Health Disparities with gift funds from Dan L Duncan in 2007.

Cancer Prevention Grants

“Our comprehensive approach to improve screening started with education through the Forum Theater Project, an interactive form of community theater, and we think this is a unique and effective way to reach our target groups.”    –Dr. Maria Jibaja-Weiss

Fortunately a very significant pool of funds to support education and prevention efforts was made available through the Cancer Prevention and Research Institute of Texas.  Jibaja-Weiss and her colleagues have successfully competed for three separate large prevention grants from CPRIT to put their ideas into practice here in Harris County. The initial project, funded in 2010, enabled the creation of the Community Network for Cancer Prevention, a collaboration of Baylor, the Harris Health System, The University of Texas MD Anderson Cancer Center, UT Health Science Center in Houston and several other community-based organizations.

The strategies adopted by the Community Network were to provide culturally and linguistically appropriative colorectal and cervical prevention education to the medically underserved population and to employ a patient navigator model to help overcome barriers to screening and subsequent follow-up and treatment.

Specific education and outreach activities included a novel theater outreach program to increase awareness of colorectal and cervical screening, point-of-care videos designed to educate patients about cancer screening in the exam room, and other collateral education materials, such as dedicated phone lines for patient education and fecal immunochemical test, or FIT, distribution bags. The FIT bags provide detailed instructions and a specimen collection kit for at-home testing, results of which determine the need for further colorectal cancer screening through a colonoscopy.

“Our comprehensive approach to improve screening started with education through the Forum Theater Project, an interactive form of community theater, and we think this is a unique and effective way to reach our target groups,” said Jibaja-Weiss.

The plays integrated culturally-appropriate screening messages to members of the Hispanic, African American and Vietnamese communities in Harris County.  A total of 1,471 community members were reached through a series of performances, and 1,471 completed pre- and post-performance survey in which they indicated a significant increase in their intention to screen for colorectal and cervical cancer.

“The patient navigator model is also an important piece of the puzzle to increase screening and follow-up of abnormal results,” Jibaja-Weiss said.

These trained professionals assist and track patients with abnormal screening results in the Harris Health system to ensure that they receive appropriate follow-up diagnostic testing. They contact patients to remind them of appointments and also work with healthcare providers to remind them to notify patients of results and make appropriate referrals.

In addition to the initiatives of the Community Network for Cancer Prevention, efforts led by Dr. Matthew Anderson, assistant professor of obstetrics and gynecology at Baylor, supported by a CPRIT grant received in 2012, have focused on providing better access to cervical cancer screening and the treatment of pre-cancerous lesions identified by a Pap test.

Anderson has partnered with the Harris Health System to pilot a medical home model for providing cervical cancer screenings and investigate why some women do not participate. The goal of these medical homes is to make cervical cancer screening much more accessible to the many women who fail to engage in this important preventive measure. A second key goal for this project is to determine how best to get women with abnormal Pap test results in for follow up, including for a procedure called a colposcopy, and make sure that any precancerous changes do not become a more serious problem.

“There are surprisingly few options for women with an abnormal Pap test results to be evaluated if they lack access to adequate health insurance. It’s a real roadblock to preventing cervical cancer,” said Anderson.

Anderson has also found that use of a patient navigator has a dramatic impact on helping women stay on track and making sure that they complete their evaluation and treatment.

Impact on the Community

These screening programs have proven successful since their inceptions. The number of patients completing fecal tests as well as follow-up colonoscopies has increased over the three-year period of the grant, while the wait time for the follow-procedure has decreased. In addition, the number of patients completing a Pap test also has increased, and Anderson and his colleagues have exceeded their goal in terms of number of patients provided with a follow-up test called a colposcopy while the wait-time for the colposcopy has decreased. 

“What’s really important is that we were able to detect hundreds of patients with early stages of colorectal cancer as well as early stages of cervical cancer. This is significant, because we know that detection of these cancers in early stages often leads to improved chances of survival,” Jibaja-Weiss said.

“While the breast cancer project has only recently begun, we expect similar improvements in breast cancer screening and follow up among Harris County’s uninsured and underinsured residents,” she added.

Office of Outreach and Health Disparities

The goal of the Office of Outreach and Health Disparities at the Duncan Cancer Center is to ensure that the large, diverse, and underserved population of Houston/Harris County receives the latest information about cancer, its prevention and treatment. For more information on the office’s community activities, free educational materials, informative and engaging theater programs, volunteer programs, and more visit www.bcm.edu/cancercenter/prevention or contact 713-798-3636.