There is a significant need for cancer outreach, education, and screening in the Rio Grande Valley, the four-county region located in the southernmost tip of Texas along the border with Mexico. Although the region boasts many assets, it is notorious for its socioeconomic and health-related challenges. Valley counties rank among the worst in Texas in terms of behavioral, social, and environmental factors that affect health. Despite the high level of health care spending, health disparities and a poor health environment still prevail (Gawande, 2009).

The average age-adjusted cervical cancer incidence and mortality rates for Cameron and Hidalgo Counties (not available for Starr and Willac...

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Need: There is a significant need for cancer outreach, education, and screening in the Rio Grande Valley, the four-county region located in the southernmost tip of Texas along the border with Mexico. Although the region boasts many assets, it is notorious for its socioeconomic and health-related challenges. Valley counties rank among the worst in Texas in terms of behavioral, social, and environmental factors that affect health. Despite the high level of health care spending, health disparities and a poor health environment still prevail (Gawande, 2009).

The average age-adjusted cervical cancer incidence and mortality rates for Cameron and Hidalgo Counties (not available for Starr and Willacy Counties) for 2006-2010 exceeded State averages for those years (Texas Cancer Registry, 2013). Breast and cervical cancer incidence rates increased in both Cameron and Hidalgo Counties during that time period. The same was true of breast and colorectal cancer mortality rates in Hidalgo County. In Texas’s Public Health Administrative Region 11, where the Rio Grande Valley is located, 34.7% of women 40 years and older reported that they had not had a mammogram within two years, as compared to 30.0% for the State of Texas and 24.6% nationwide (Center for Health Statistics, 2010). Also in Region 11, 24.4% of women 18 years and older reported that they had not had a pap smear within three years, as compared to 20.6% for the State and 18.1% nationwide. Of adults 50 years of age and older in Region 11, 86.5% were at risk for not having a Blood Stool Test in the past two years, slightly higher than state and national figures. Of adults 50 years of age and older, 47.6% had never had a colonoscopy, compared to the 38.5% State rate.

The proposed Cada Paso del Camino (Every Step of the Way) project is a comprehensive prevention strategy for breast, cervical, and colorectal cancers in the Valley. Specifically, through partnerships between the nonprofit organization MHP Salud, state-funded clinical provider Rio Grande State Center (RGSC), clinical provider Valley Cancer Associates, and the University of Texas Health Science Center’s Mario E. Ramirez, M.D. Medical Library, Cada Paso del Camino will provide Promotor(a) outreach and education, screening, diagnostic testing, and referrals for Health Insurance Marketplace enrollment assistance and/or other options for obtaining affordable treatment.

The project will focus on reaching uninsured, underserved Hispanic residents in colonias surrounding the city of Harlingen, located in Cameron County. Colonias is this area often fall between the cracks of health promotion/disease prevention programming.

The overall, three-year goals of Cada Paso del Camino are as follows: (1) Increase cancer screening and rescreening at the Rio Grande State Center (RGSC) from baseline of 0 by 1,705 screenings; (2) 100% of RGSC clients whose initial screening results are abnormal will be offered affordable diagnostic services and – if needed – treatment. The total number of people to be served by the project is 11,852.

The connection between the proposed project and an existing MHP Salud program that offers enrollment assistance for the Health Insurance Marketplace is an innovative component. By helping eligible uninsured and underinsured individuals access adequate health insurance, the project will ensure that CPRIT funds and other resources are dedicated to the people who need them the most, including those who are eligible neither for Medicaid nor subsidies to purchase private insurance through the Health Insurance Marketplace. Another innovative component of the project relates to a past partnership between MHP Salud and regional transit provider Valley Metro that aimed to reduce transportation barriers by providing outreach and education on the transit system to residents of isolated communities. Outreach and education provided by MHP Salud under Cada Paso del Camino will include information about Valley Metro’s services and how they can be used to access RGSC, which has a stop on site. MHP Salud will also provide Valley Metro vouchers to individuals who need them in order to travel to their appointments.

Cada Paso del Camino offers a unique partnership model that incorporates Promotor(a) outreach and education, clinical screening and diagnostic services, and access to health insurance enrollment assistance and other mechanisms for obtaining affordable treatment. Project results can be used to inform similar future efforts within and beyond Texas’s Rio Grande Valley and will be disseminated via MHP Salud's national training and technical assistance arm. With the growing emphasis in the U.S. health care system on improving the quality and coordination of care, promoting patient engagement, reducing costs, and improving health outcomes, there could be no better time to initiate Cada Paso del Camino.

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