Mobile Health Clinic spreads cervical cancer awareness in the Rio Grande Valley
With the mission of improving cervical cancer prevention efforts in the Rio Grande Valley, the Mobile Health Clinic of the Department of Internal Medicine helped to create a comprehensive community-based initiative to bring higher standards of health care to underserved women in the region.
The Mobile Health Clinic of the Department of Internal Medicine has been serving the medical needs of children and adults in the lower Rio Grande Valley along the Texas-Mexico border since 1998. The clinic offers no-cost medical consultations, basic health service, and patient education to underserved women.
The collaboration, which led to the publication of the paper “Cervical cancer prevention in the Rio Grande Valley,” also included The University of Texas MD Anderson Cancer Center, the UTHealth School of Public Health, including the Brownsville Regional Campus; The University of Texas Medical Branch; The University of Texas Rio Grande Valley; Su Clinica, and The Dysplasia & Cancer Stop Clinic.
Though preventable, cervical cancer presents 570,000 new cases and 311,000 deaths annually, with more than 85 percent of cervical cancer cases occurring in low- and middle-income countries. The incidence and mortality rates for cervical cancer in the Rio Grande Valley, are nearly 55 percent higher than the average rates in the United States
According to the paper, preventative vaccines hold great promise to treat cervical cancer, which is caused by persistent infection with high-risk types of human papillomavirus (HPV). However, nearly 50 percent of children do not complete the vaccine series.
The program began in November 2014 and consisted of a three-pronged approach with community education, patient navigation, and a training and mentoring program for local medical providers.
For education, community health care workers, known as promotoras, helped spread information on cervical cancer screening and HPV vaccination through both individual outreach, and community events such as health fairs, school meetings, and Zumba/yoga classes. Additionally, women in the waiting rooms or internal medicine clinics, and those who were past due for cervical cancer screening, also received education information.
Following the education, patients interested and eligible for screenings were directed to either the Mobile Health Clinic or one of the participating clinics in the area for a cervical cancer screening. If any women showed abnormal screening results, follow-up care was provided.
During the four years of the program’s existence, 10,849 women from more than 1,800 community events received education about HPV vaccination and cervical cancer screening, and were informed to go to either the Mobile Health Clinic or McAllen Clinic for care, while an additional 9,001 women already in the Su Clinica system received education as well.
In total, 14,846 women underwent cervical cancer screening with cytology +/- HPV testing at the participating clinics, with 2,030 women needing colposcopies for abnormal results. Through the course of the project, 453 loop electrosurgical excision procedures (LEEP) were performed, and only 76 women (3.7%) did not return for follow-ups. In the final year of the initiative, 73.5 women per month received colposcopy at one of the facilities, a 179% increase compared to the year prior to the beginning of the study.
The final step of the program provided colposcopy and LEEP training for local physicians and advance practice providers to ensure growth of the local capacity to handle cervical cancer prevention.
Health care professionals received training from the ASCCP Colposcopy Mentorship Program, as well as supplemented, locally-held and free-of-charge training courses developed by bioengineers at Rice University (LUCIA models). Physicians also utilized Project ECHO, a telementoring program designed to provide guidance from academic specialists in an online, mentoring platform.
Five providers attended the ASCCP training course and mentoring program, while two more providers were trained to perform LEEP. Additionally, two hands-on colposcopy and LEEP courses were held in the area with 35 and 25 participants attending each, respectively. Through Project ECHO, sessions were held every two weeks, totaling 101 sessions overall with an average of 22 participants per session.
“We demonstrated that a comprehensive, community-based approach to cervical cancer prevention is feasible in the RGV and led to an increase in the number of women being diagnosed and treated for cervical dysplasia and cancer,” the authors said. “Through these efforts, we aim to significantly decrease the burden of cervical cancer in Texas and use the findings to help inform future work towards the elimination of cervical cancer.”
Authors for the paper from the Department of Internal Medicine include Paul A. Toscano, physician’s assistant, and Flor E. Valdez, medical assistant.