Rural Texas counties have a greater cancer burden than their urban counterparts due to access-to-care barriers (being uninsured, poor and with limited transportation) and lack of infrastructure to carry out prevention programs. With more than 80% of Texas designated rural by federal government standards, 3.3 million people live in rural communities. Moreover, most uninsured Texan adults are low-income workers: nearly 70% of uninsured adults are in a working family, and 40% live below the poverty level. Despite healthcare reform, Texas still has the highest number of uninsured, non-elderly adults in the nation at just over 23%.

Access to health care for the uninsured in Texas is a growing, lo...

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Rural Texas counties have a greater cancer burden than their urban counterparts due to access-to-care barriers (being uninsured, poor and with limited transportation) and lack of infrastructure to carry out prevention programs. With more than 80% of Texas designated rural by federal government standards, 3.3 million people live in rural communities. Moreover, most uninsured Texan adults are low-income workers: nearly 70% of uninsured adults are in a working family, and 40% live below the poverty level. Despite healthcare reform, Texas still has the highest number of uninsured, non-elderly adults in the nation at just over 23%.

Access to health care for the uninsured in Texas is a growing, long-term problem as many uninsured adults have little or no connection to the healthcare system. Those that do have a health home rely on federally qualified health centers and public hospitals, which are already operating at capacity and these facilities are generally not equipped to provide specialty care such as breast cancer screening and diagnostic testing. Long-term concerns include the rate of population growth and the reduction of state-funded programs that help low-income women in need of breast cancer screening, diagnostics and treatment.

Rural Texas women are more likely to have breast cancers diagnosed at a later, more invasive stage thus reflecting higher breast cancer mortality rates. According to the Texas Cancer Registry, breast cancer mortality rates are higher than the Texas’ rate of 21.3 per 100,000 in 15 of the 34 targeted counties (ranging from 34.9 – 21.3 age-adjusted rate per 100,000). The Rose seeks renewal grant funding in the amount of $1,500,000 over 24 months to support the successful progress and expansion of the CPRIT-funded Empower Her® to Care project. This project (the Empower Her to Care Expansion) will continue to increase the delivery of breast cancer screening, diagnostic procedures and patient navigation services to 3,700 underserved women in 34 southeast Texas counties.

The two-year project will serve 3,700 underserved/uninsured women, age 40 and above, who have not had a mammogram within the last five years or are not regularly receiving mammograms and live within 34 Texas counties. The expansion effort will focus on serving ten additional counties within the last nine months of the project. The Empower Her® to Care program’s current service area includes Austin, Brazoria, Burleson, Chambers, Colorado, Fort Bend, Galveston, Hardin, Harris, Jasper, Jefferson, Liberty, Matagorda, Montgomery, Newton, Polk, Sabine, San Augustine, San Jacinto, Shelby, Tyler, Waller, Washington, and Wharton counties. The expansion will add Angelina, Brazos, Trinity, Walker, Leon, Robertson, Madison, Orange, Grimes, and Nacogdoches counties.

Services will be provided through The Rose’s digital Mobile Mammography Program through partnerships with established community clinics, physicians and other organizations that offer education/outreach efforts and clinical breast exams to recruit eligible women in need of screening. Diagnostic testing, coordinated care and access to breast cancer treatment will be provided at either of The Rose’s two locations. By addressing transportation, financial and system barriers, the Empower Her to Care Expansion project will increase access to preventive services, a continuum of care unique to these communities.

To address barriers, The Rose will apply the following evidenced-based models to promote cancer prevention and control: 1) reduce structural barriers through mobile mammography, 2) reduce out-of-pocket costs for services and transportation (CPRIT-sponsored care), 3) apply client reminders for appointments; 4) reducing structural barriers through patient navigation services to ensure timely access to diagnostic testing and treatment.

The Empower Her to Care Expansion project will serve 3,700 unique clients (Y1=1,800 and Y2=1,900 over 24 months needing access to mammography screenings, diagnostic follow-up, coordinated care and access to treatment with the overall goal of reducing breast cancer mortality in Texas.

With CPRIT partnership, the Empower Her to Care Expansion project will help to increase breast cancer screening awareness, promote the availability of CPRIT program funding to increase access to care, deliver services and coordinated care, and strengthen (or create) safety-net systems. Since implemented in 2010, CPRIT Empower Her to Care funding has served 7,866 Texas women needing access to breast health services (3,030 were first-ever mammogram). Of those served, 201 breast cancers were detected and 69 (34%) of those cancers were ultimately detected through first-ever mammograms. Empower Her to Care is making a significant impact in Texas, saving lives and improving safety-net systems for long-term community health.

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