Need: This proposal expands our current successful CPRIT screening project from 19 to 32 primarily rural counties in East Texas, effectively covering the entire East Texas region that suffers from alarming CRC incidence and mortality rates. Colorectal cancer (CRC) is the fourth most frequently diagnosed and second most fatal cancer in the United States(36). However, the majority of CRC can be prevented with preventive screenings such as fecal immunochemical testing (FIT) and colonoscopy. East Texas, a primarily rural, medically underserved area of Texas approximately the size of West Virginia, is disproportionately affected by higher rates of CRC incidence and mortality when compared to both...
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Need: This proposal expands our current successful CPRIT screening project from 19 to 32 primarily rural counties in East Texas, effectively covering the entire East Texas region that suffers from alarming CRC incidence and mortality rates. Colorectal cancer (CRC) is the fourth most frequently diagnosed and second most fatal cancer in the United States(36). However, the majority of CRC can be prevented with preventive screenings such as fecal immunochemical testing (FIT) and colonoscopy. East Texas, a primarily rural, medically underserved area of Texas approximately the size of West Virginia, is disproportionately affected by higher rates of CRC incidence and mortality when compared to both state and national averages (19,21,22,37). The population is disproportionately older, with a larger proportion of non-Hispanic White and African American residents. Access to primary/specialty care is limited due to a lack of providers, distance to care, and high rates of poverty(19). CRC screening is among the highest ranked preventive service available and offers substantial opportunities to improve population health, but has traditionally been underutilized(1). Few in Texas, especially the un- or under-insured, receive these services: 6.8% vs 9.1% who have insurance completed a stool blood test in the last year, and 28.1% vs. 57.8% who have insurance completed a flexible sigmoidoscopy in the last 5 years or a colonoscopy in the last 10. (38). Overall Project Strategy: This proposal expands our current CRC screening project from 19 to 32, primarily rural counties in East Texas, increasing the area served by 68%. The 13 additional counties (Bowie, Camp, Cass, Franklin, Harrison, Hopkins, Marion, Morris, Panola, Rains, Red River, Titus, Upshur) are not currently served by a CPRIT-funded CRC screening program. However, individuals from the expansion counties have already begun attending educational events. In addition, we have received exceptional support to begin screening services in this region. We will partner with public health departments/districts, Federally Qualified Health Centers, charity clinics, businesses and faith-based organizations to increase CRC education and screening services. Our proposal will focus on initial CRC screening using fecal immunochemical testing and proceed to colonoscopy if a positive/abnormal result is found. Specific Goals: This Project has two goals: 1) To increase CRC screening education in a 32-county mostly rural area of East Texas, and 2) to increase the rate of CRC screening in the same area. We will reach 30,000 individuals and serve 8,500 individuals. Significance and Impact: As mentioned above, East Texas is in great need of a CRC screening project due to the high rates of CRC when compared to state and national averages. This project has successfully demonstrated, in the 19 original counties, that we are able to educate and screen individuals from this rural region with our unique approach. It is unique and non-duplicative because most CRC screening projects focus on urban and suburban populations, and typically use a clinical model for recruitment. Rural populations pose unique challenges due to lack of proximity to providers and a population difficult to reach due to wide geographic distribution. Whereas urban CRC screening projects generally focus on a clinically driven approach to education and recruitment, we developed a unique approach integrating both public health and clinical models which account for rurality and optimizes success. Our improved access to care model incorporates strong partnerships with regional collaborators, engaging numerous community health facilities to create awareness of CRC screening options and recruit screening participants. Previous projects on cancer education, screening, and follow-up have been well received and effective in this region of East Texas. This project leverages the availability of robust primary care programs at UTHSCT to assist with recruitment for CRC screening. Other than ours, there are no known organized CRC screening initiatives operating on a large scale in the targeted 32-county region which provide both CRC education and screening services to the underserved. The proposal is designed to reach and serve as many individuals as possible with these potentially lifesaving screening activities.
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