Addressing cervical cancer disparities in Texas: Expansion of a community-based prevention initiative for medically underserved populations

Although cervical cancer is preventable, significant disparities exist in access to screening and prevention services. In medically underserved areas (MUAs) of Texas, these rates are 55% higher compared to the remainder of the US. In 2019, we expanded a multicomponent, comprehensive program to improve cervical cancer prevention in partnership with 13 clinics and mobile vans in MUAs of Texas. Our multicomponent intervention program consists of community education and patient navigation coupled with a training/mentoring program for local medical providers to perform diagnostic procedures and treatment for patients with abnormal screening results. Hands-on training courses to learn these skills are coupled with biweekly telementoring conferences using Project ECHO® (Extension for Community Healthcare Outcomes). This program was implemented in 2015 and expanded to other MUAs in Texas in 2019. From March 2019 to August 2022, 75,842 individuals were educated about cervical cancer screening and HPV vaccination. A total of 44,781 women underwent screening for cervical cancer, and 2,216 underwent colposcopy and 264 underwent LEEP. High-grade cervical dysplasia was diagnosed in 658 individuals and invasive cervical cancer in 33 individuals. We trained 22 providers to perform colposcopy and/or LEEP. In addition, 78 Project ECHO telementoring sessions were held with an average of 42 attendees per session, with 72 individual patient cases discussed. Our comprehensive community-based prevention initiative for medically underserved populations has led to a significant number of individuals undergoing cervical cancer screening in MUAs, as well as improved access to colposcopy and LEEP services

Addressing Cervical Cancer Disparities in Texas: Expansion of a Community-Based Prevention initiative For Medically Underserved Populations

Although cervical cancer is preventable, significant disparities exist in access to screening and prevention services. In medically underserved areas (MUAs) of Texas, these rates are 55% higher compared to the remainder of the US. In 2019, we expanded a multicomponent, comprehensive program to improve cervical cancer prevention in partnership with 13 clinics and mobile vans in MUAs of Texas. Our multicomponent intervention program consists of community education and patient navigation coupled with a training/mentoring program for local medical providers to perform diagnostic procedures and treatment for patients with abnormal screening results. Hands-on training courses to learn these skills are coupled with biweekly telementoring conferences using Project ECHO® (Extension for Community Healthcare Outcomes). This program was implemented in 2015 and expanded to other MUAs in Texas in 2019. From March 2019 to August 2022, 75,842 individuals were educated about cervical cancer screening and HPV vaccination. A total of 44,781 women underwent screening for cervical cancer, and 2,216 underwent colposcopy and 264 underwent LEEP. High-grade cervical dysplasia was diagnosed in 658 individuals and invasive cervical cancer in 33 individuals. We trained 22 providers to perform colposcopy and/or LEEP. In addition, 78 Project ECHO telementoring sessions were held with an average of 42 attendees per session, with 72 individual patient cases discussed. Our comprehensive community-based prevention initiative for medically underserved populations has led to a significant number of individuals undergoing cervical cancer screening in MUAs, as well as improved access to colposcopy and LEEP services

Identification of 12 new susceptibility loci for different histotypes of epithelial ovarian cancer.

To identify common alleles associated with different histotypes of epithelial ovarian cancer (EOC), we pooled data from multiple genome-wide genotyping projects totaling 25,509 EOC cases and 40,941 controls. We identified nine new susceptibility loci for different EOC histotypes: six for serous EOC histotypes (3q28, 4q32.3, 8q21.11, 10q24.33, 18q11.2 and 22q12.1), two for mucinous EOC (3q22.3 and 9q31.1) and one for endometrioid EOC (5q12.3). We then performed meta-analysis on the results for high-grade serous ovarian cancer with the results from analysis of 31,448 BRCA1 and BRCA2 mutation carriers, including 3,887 mutation carriers with EOC. This identified three additional susceptibility loci at 2q13, 8q24.1 and 12q24.31. Integrated analyses of genes and regulatory biofeatures at each locus predicted candidate susceptibility genes, including OBFC1, a new candidate susceptibility gene for low-grade and borderline serous EOC

Managing family conflict over career decisions: The experience of Asian Americans

Conflict over career decisions is a main source of intergenerational conflict among Asian American families. This qualitative study explored the topic using consensual qualitative research methodology in a sample of eight Asian Americans. Results indicated that participants experienced feelings of guilt and indebtedness due to conflicting values, traditions, and expectations. Most participants dealt with parental disapproval regarding their career choice by seeking advice from friends and relatives. Participants employed many strategies to earn approval such as educating parents about their chosen career, seeking honors, and compromising between personal desires and parental expectations. Implications for career counseling and research are discussed

Transforming Growth Factor β Induces Rosettes of Podosomes in Primary Aortic Endothelial Cells

Cytoskeletal rearrangements are central to endothelial cell physiology and are controlled by soluble factors, matrix proteins, cell-cell interactions, and mechanical forces. We previously reported that aortic endothelial cells can rearrange their cytoskeletons into complex actin-based structures called podosomes when a constitutively active mutant of Cdc42 is expressed. We now report that transforming growth factor beta (TGF-β) promotes podosome formation in primary aortic endothelial cells. TGF-β-induced podosomes assembled together into large ring- or crescent-shaped structures. Their formation was dependent on protein synthesis and required functional Src, phosphatidylinositide 3-kinase, Cdc42, RhoA, and Smad signaling. MT1-MMP and metalloprotease 9 (MMP9), both upregulated by TGF-β, were detected at sites of podosome formation, and MT1-MMP was found to be involved in the local degradation of extracellular matrix proteins beneath the podosomes and required for the invasion of collagen gels by endothelial cells. We propose that TGF-β plays an important role in endothelial cell physiology by inducing the formation of podosomal structures endowed with metalloprotease activity that may contribute to arterial remodeling

Integration of Cervical and Breast Screening and Early Detection Training

This presentation shares results from a survey administered to providers who attended the Cervical and Breast Cancer Prevention Training workshop at the University of Texas MD Anderson Cancer Center. The survey examined the need for and feasibility of integrated cervical and breast cancer screening and early detection training in Texas and found that integrated training shows promise for acceptance and practicality.https://openworks.mdanderson.org/soar24/1002/thumbnail.jp

Elimination of cervical cancer in Latin America (Project ECHO-ELA): lessons from phase one of implementation

We describe the outcomes of The Extension for Community Healthcare Outcomes-Elimination of Cervical Cancer in The Americas (ECHO-ELA) program, which was developed as a tri-lateral cooperation between Pan American Health Organization (PAHO), the U.S. National Cancer Institute (NCI) and The University of Texas MD Anderson Cancer Center (MD Anderson). The program’s purpose is to disseminate strategies for cervical cancer prevention and is structured around the three pillars of the World Health Organization’s (WHO) Cervical Cancer Elimination Strategy and the associated 90-70-90 target goals. The target audience includes health authorities from Latin American and Caribbean countries, as well as PAHO’s non-communicable disease Focal Points in country offices as well as clinical and public health collaborators. The virtual sessions are held in Spanish for 1.5 hours every month using the ECHO® format. From May 2020 to June 2021, 14 ECHO sessions were held with an average of 74 participants per session (range: 46 – 142). We conducted two anonymous surveys (baseline and follow up) and two focus groups. Respondents stated that the topics they learned the most about included the state of HPV vaccination in the region and strategies for implementing HPV vaccination. Identified needs included support between ECHO sessions and country-specific technical assistance. The ECHO-ELA program provides a forum for increased collaboration between countries in Latin America/Caribbean and the dissemination of best-practice strategies to reach the WHO Cervical Cancer Elimination target goals

Cervical cancer prevention program in Nepal: a ‘training of trainers’ approach

# Background Cervical cancer remains the leading cause of cancer-related death among Nepalese women. To this effect, Cancer Care Nepal established an international collaboration to implement a 'training of trainers' (TOT) program to expand the reach of cervical cancer prevention techniques. # Methods The Nepal cervical cancer prevention program began with an in-person TOT session in Kathmandu in November 2019. Due to the COVID-19 pandemic, two additional TOT courses were held in October and November 2021 with virtual support, didactic lectures from international faculty, and a hands-on component by Nepalese faculty. The Nepalese providers underwent training in these courses and then held further training in five collaborating centers across Nepal. Participants completed pre- and post-course knowledge assessments. The trainings were supplemented by the creation of a new Project ECHO® (Extension for Community Healthcare Outcomes) telementoring hub at Cancer Care Nepal. A capstone refresher course was held in November 2022. # Results 42 participants attended the initial TOT course in 2019. The two follow-up TOT courses held in October/November 2021 were two days long and included providers from five participating regions in Nepal. The courses included virtual didactic sessions followed by hands-on stations led by the Nepalese faculty who had participated in the 2019 TOT course. The stations included: visual inspection with acetic acid (VIA), colposcopy, thermal ablation, and loop electrosurgical excision procedure (LEEP). There were 41 participants in the October/November TOT courses. The trainers who received the TOT education then conducted local courses of similar content in each of the five regions for 152 local providers. Participants had improved mean knowledge scores after the training (0.70, 95% CI=0.67-0.72) in comparison to prior to training (0.50, 95% CI=0.47-0.53), p\<0.001. The program concluded with a capstone course in November 2022 attended by 26 participants. To date, 11 Project ECHO sessions have been held, with an average of 20 participants per session. # Conclusions Nepal's cervical cancer prevention program has increased the number of providers trained in cervical cancer prevention techniques. By increasing provider capacity, individuals will have increased access to cervical cancer screening and treatment of pre-invasive disease, hopefully decreasing the burden of cervical cancer in Nepal