Center for Prevention and Population Health Research

Barriers to lung cancer screening exist among communities with low access to healthcare, including rural areas. Primary care clinicians have cited the need for improvement in clinical processes, including needing support for identifying patients, referral, screening, and follow-ups. These barriers result in real-life consequences. Rural residents experience higher lung cancer mortality and late-stage disease compared to those in urban areas, a fact that is especially important in Texas, a state with both large urban and rural regions. According to the American Lung Association, Texas only detects 23.4 percent of cases at an early stage, a lower rate than 26.6 percent across the United States. Texas ranks 48 out of all the states for lung cancer screening, indicating the need for additional services and training for clinicians who serve the most at-risk communities and those with limited access to healthcare. 

The lung cancer prevention and dissemination projects focus on educating primary care clinicians in both urban and rural areas of Texas on how to identify eligible patients and conduct shared decision-making with them to determine whether screening for lung cancer using low-dose computed tomography (LDCT) is appropriate. The program also supports screening and navigation services among uninsured patients to ensure lung cancer screening is available to all. Current smokers are encouraged to participate in nicotine cessation services, including nicotine replacement therapy and counseling services, also provided through the program. Since this program was implemented, Harris Health started covering LDCT lung cancer screening as an approved benefit. Further, the program expanded to offer services in two rural communities, including Angelina and Brazoria Counties, the border region, and FCM clinics. Dissemination efforts include educating more primary care clinicians in rural areas of Texas and offering a toolkit for success. 

Our colorectal and breast cancer projects, funded by CPRIT, include the Rural and Urban Network for Cancer Prevention through Outreach and Education (RUN-CPOE), a comprehensive community outreach initiative led by Luis Rustveld, Ph.D., RD, LD. The primary goal of RUN-CPOE is to educate community members to prioritize timely breast and colorectal cancer (BC/CRC) screenings, and to adopt healthier lifestyles by addressing modifiable risk factors such as body weight, alcohol consumption, physical activity, diet, and smoking. RUN-CPOE is a collaborative effort involving experts and staff from our department with Baylor College of Medicine’s Lester and Sue Smith Breast Center, Dan L Duncan Comprehensive Cancer Center, and East Texas Network of Care. Additional key partners include CHI St. Luke’s Health – The Woodlands, American Cancer Society, Las Rosas Vivas, the Mexico and El Salvador Consulates in Houston, and several churches.

We actively engage the community through a variety of outreach events, including educational health fairs, presentations hosted by community service agencies, and performances of cancer focused monologues and plays. These performances aim to convey complex screening guidelines and cancer prevention strategies in an engaging, accessible, and relevant manner. Our community partners assist with identifying venues, coordinating logistics, and encouraging participation among the populations they serve. After each performance, our cancer experts facilitate a brief Q&A session to address audience questions and concerns. To assess the impact of these events, audience members are provided with pre- and post-event evaluation cards to measure changes in their screening intentions and understanding of cancer prevention strategies.