Cancer Prevention & Control Research Program

The Coordinating Center for Colorectal Cancer Screening across Texas — known as CONNECT — aims to drive and support colorectal cancer screening efforts. Compared to the rest of the U.S., Texas sits in the bottom quartile of up-to-date colorectal cancer screening in adults of eligibility screening age.

Funded by the Cancer Prevention & Research Institute of Texas, CONNECT will create a statewide stakeholder network to develop, implement and disseminate a Texas colorectal cancer screening strategic plan to galvanize screening across the state. Additionally, the center seeks to leverage infrastructure and resources to support the expansion of colorectal screening across the state, with a focus on medically underserved populations. CONNECT is centered in the Department of Population Health and is led by Navkiran Shokar, M.D., MPH, in partnership with multiple organizations across Texas.

CONNECT serves as a convening entity and central hub of resources, tools and content expertise accessible by stakeholders across the state, working to achieve the following goals:

• Create a comprehensive stakeholder network representing all regions and communities in Texas to inform development, implementation and dissemination of a Texas colorectal cancer screening strategic plan.
• Develop infrastructure and resources to support expansion of evidence-based colorectal cancer screening statewide.
• Use rigorous evaluation methods and innovative approaches of modeling, geospatial mapping and cost-effective analyses to assess impact and support planning, implementation and policy development.
• Accelerate the creation, implementation and dissemination of colorectal cancer screening best practices for priority populations.

Screening and Prevention of Alcohol-Related Cancers — known also as SPARC — is an innovative program implementing alcohol-use screening and treatment in primary care settings as a means of cancer prevention.

In Texas, 1 in 5 people report heavy drinking and, in some counties, it is closer to 1 in 4 people. Alcohol is a known risk factor for head and neck, breast, liver, esophageal and colorectal cancers. Despite being effective in reducing unhealthy alcohol use, screening and treatment interventions have not been widely implemented.

With funding from the Cancer Prevention & Research Institute of Texas, the overall goal of SPARC is to provide resources within primary care settings at CommUnityCare Health Centers and Lone Star Circle of Care for screening and treatment for patients with unhealthy alcohol use.

The specific goals of SPARC are to:

• Sustain high rates of engagement among patients who screen positive on the initial clinical screening for alcohol use.
• Successfully refer patients who have high likelihood of alcohol use disorder to additional counseling or treatment.
• Reduce risky drinking behavior among patients who screen positive on the full AUDIT screening tool.

The SPARC program began March 2020 and is led by Jessica Calderon-Mora, DrPH.

The Lung Cancer Screening and Tobacco Cessation Program provides critical services to high-risk patients at CommUnityCare Health Centers and Lone Star Circle of Care.

Lung cancer is the second-most common cancer in men and women and the most common cause of cancer death in Central Texas, and smoking is the leading cause of preventable mortality and strongest risk factor for lung cancer. Effective lung cancer screening and tobacco cessation interventions are underused due to the time and resources required.

Through a Cancer Prevention & Research Institute of Texas grant, this program provides evidence-based prevention and screening services to make lung cancer screening and engagement in tobacco cessation more accessible.

The specific goals of the Lung Cancer Screening and Tobacco Cessation Program are to:

• Increase the number of high-risk patients who engage in intensive smoking cessation counseling.
• Increase the number of high-risk patients who successfully complete the lung cancer screening process.

The Lung Cancer Screening and Tobacco Cessation Program began August 2019 and is led by Brandon Altillo, M.D., MPH.

Unidos Contral el VPH/United Against HPV presents a unique opportunity to evaluate preferences for cervical cancer self-collection techniques while providing education and screening among patients who are unscreened.

Compared to national rates, cervical cancer screening rates among women living along the U.S.-Mexico border are low, leading to higher incidence and mortality. Funded by the Cancer Prevention & Research Institute of Texas, this program increases access to cervical cancer screening and evaluates the patient preferences in at-home collection (urine or cervicovaginal) compared to in-clinic testing (standard of care pap with HPV co-testing).

The specific aims of this program are to:

• Compare the effectiveness of three cervical cancer screening methods to improve cervical cancer screening completion: in-home urine collection, in-home cervicovaginal swab or in-clinic clinician-obtained samples.
• Compare beliefs and preferences of HPV self-collection methods to clinician-collected samples.

Unidos Contral el VPH/United Against HPV began March 2024 and is led by Jessica Calderon-Mora, DrPH.

The Central Texas Colorectal Cancer Screening Program continues to expand its services to increase colorectal cancer screening, prioritizing mailed at-home screening tests, patient navigation, community outreach and education, and increased access to screening, including colonoscopy services.

Colorectal cancer is the third most common cancer and third leading cause of cancer death in the U.S. Screening rates continue to fall below targets nationally and are even lower among certain populations. By leveraging our ongoing partnerships with CommUnityCare Health Centers, Lone Star Circle of Care andDigestive Health, while expanding to include Bluebonnet Trails Community Services, Vivent Health, Black Men’s Health Clinic and the Austin Asian Community Health Initiative, this Cancer Prevention & Research Institute of Texas-funded program improves education, messaging and engagement to increase colorectal cancer screening rates in Central Texas.

The specific goals of the program are to:

• Expand access to an effective, multimodal mailed FIT program.
• Integrate evidence-based health promotion components to improve colorectal cancer screening rates.
• Improve longitudinal colorectal cancer screening adherence.
• Provide successful navigation services for patients with abnormal FIT results as well as for those diagnosed with colorectal cancer.

The Central Texas Colorectal Cancer Screening Program began August 2017 and is led by Navkiran Shokar, M.D., MPH.

The Inpatient Alcohol and Tobacco Screening and Treatment Program uses evidence-based practices to offer screening and treatment for patients who screen positive for alcohol or tobacco use in a hospital-based setting.

Alcohol is a known risk factor for certain types of cancer, including head and neck, breast, colorectal and liver cancer. Smoking is the strongest risk factor for lung cancer. In the U.S., 15%-20% of adults report binge drinking in the past month, and about 12% of U.S. adults smoked cigarettes, and 19% use any tobacco.

With funding from the Cancer Prevention & Research Institute of Texas, this program provides screening and treatment initiation for tobacco and unhealthy alcohol use to patients admitted to Dell Seton Medical Center.

The specific goals of the program are to:

• Increase prevalence and fidelity of universal screening for unhealthy alcohol and tobacco use for patients admitted to a single center county-serving hospital.
• Deliver a comprehensive intervention, consisting of motivational interviewing and assessment of the need for medication-assisted treatment, for patients screening positive for alcohol and/or tobacco use disorders.
• Develop a referral and follow-up plan for patients who screened positive to support decreased substance use.

The Inpatient Alcohol and Tobacco Screening and Treatment Program began August 2022 and is led by Jananie Ramesh, M.D.

The Advancing Breast Health Among Uninsured Women in Central Texas Program is a Cancer Prevention & Research Institute of Texas-funded program dedicated to breast cancer screening and early detection. Its primary objective is to address the barriers to breast cancer screening within the nine-county region in Central Texas, where socioeconomic disparities, elevated cancer rates and limited access to health care disproportionately affect rural, minority and low-income populations.

The program employs a coalition of community partners, including Lone Star Circle of Care, Ascension Seton, Austin Radiological Association, Black Men’s Health Clinic, Bluebonnet Trails and Community Health Centers of South-Central Texas.

This expanded iteration of the program builds upon the initial project of offering mobile mammography services by establishing new, fixed testing options for screening, incorporating robust community outreach, implementing health promotion education, and fostering clinical and community referral partnerships.

The specific goals of the program are to:

• Expand breast cancer screening services throughout Central Texas.
• Integrate new outreach and evidence-based education approaches.
• Ensure successful navigation of patients with abnormal screening results as well as those diagnosed with breast cancer.

The Advancing Breast Health Among Uninsured Women in Central Texas Program began in 2021 and is led by Navkiran Shokar, M.D., MPH.

The Cancer Awareness and Prevention Education Program is an intervention funded by the Shivers Cancer Foundation that seeks to create a model for comprehensive and sustainable breast, cervical and colorectal cancer screening programs.

This intervention is communiy health worker-led and provides culturally adapted and multilingual health education, co-created with community input, to assess and address barriers to cancer screening, implement culturally appropriate health promotion and education, navigate individuals to resources for low or free screening, and develop community and health system partnerships.

The specific goals of the program are to:

• Understand and document individual and system barriers to cervical, breast and colorectal cancer screening and cancer risk factors with a focus on underserved areas.
• Implement health promotion and education programs focusing on colorectal, cervical and breast cancer screening, primarily using community-based outreach, connecting individuals without a medical home to clinic services.
• Develop a multilevel, collaborative partnership of community-level stakeholders, public health organizations, health providers and systems and policymakers to develop a comprehensive care pathway for cervical and colorectal cancer.
• Plan and prepare regional evidence-based cervical cancer screening and community-based colorectal cancer programs for underserved populations.

CAPE began in 2023 and is led by Navkiran Shokar, M.D., MPH.