Research on Cancer in Underserved Communities

May 3, 2019

Researchers worked with Parkland Health & Hospital System to target underinsured people and improve access to screenings.

The greater good

How cancer research serves the community.

Medical screenings such as mammography and colonoscopy can help prevent cancer and find it early, when it’s most treatable. It’s important for screening efforts to reach everyone, especially people in underserved communities who might struggle with access to care. That’s why UT Southwestern population scientists track the success of their outreach efforts.

“As a National Cancer Institute-designated cancer center, it is important for us to track and monitor our impact on our catchment area,” says Jasmin Tiro, Ph.D., Simmons Comprehensive Cancer Center’s Associate Director for Community Outreach, Engagement, and Equity. “We need to make sure we are tracking disparities, conducting research, and putting programs in place to help achieve equity and reduce disparities.”

She adds that it’s important to identify barriers and develop interventions addressing those barriers so that everyone can benefit from cancer-preventing services.

Finding financial coverage for lifesaving screenings is a big challenge. The UT Southwestern team connects with federal, state, and private funding sources to make sure people can get the tests they need regardless of their ability to pay.

“We need to make sure we are tracking disparities, conducting research, and putting programs in place to help achieve equity and reduce disparities.”

Jasmin Tiro, Ph.D.
Simmons Comprehensive Cancer Center’s Associate Director for Community Outreach, Engagement, and Equity

Here are three ways researchers are improving access to cancer screening:

1. Increasing Turnout for Colon Cancer Screenings

Screening for colon cancer is recommended for people age 45 and older. It can identify polyps and lesions, removing them before they become cancerous, and it saves lives. But only about 15 percent of people without insurance get screened, with particularly low screening rates among African-Americans and Hispanics.

As part of a study evaluating outreach strategies, researchers worked with Parkland Health & Hospital System to target people age 50 to 64 who were underinsured. The team mailed nearly 5,000 letters to people in Dallas County informing them of their risk of colon cancer and recommending screening.

The recipients could choose between a colonoscopy or a free fecal immunochemical test (FIT) kit. About 41 percent of people who received the FIT kit and 25 percent of people who chose colonoscopy completed the recommended screening. Only 12 percent of people receiving usual care were screened.

“Our goal is to work with Parkland to build a sustainable colon cancer screening program that can be more effective than usual referral practices that stem from doctor’s office visits,” says Amit G. Singal, M.D., the David Bruton, Jr. Professor in Clinical Cancer Research and an Associate Professor in the Division of Digestive and Liver Diseases at UTSW.

The team is now focusing on improving FIT-based colon cancer screening outreach and looking at ways to maintain participation rates over time because the tests need to be repeated annually.

2. Preventing Liver Cancer by Treating Hepatitis C

The most common type of liver cancer, hepatocellular carcinoma (HCC), has a rapidly rising death rate and is striking Texas especially hard. It’s most often caused by the hepatitis C virus, so if people with hepatitis C are treated and cured, they can significantly reduce their risk of developing HCC in the future.

Baby boomers are at high risk for chronic hepatitis C infection – studies in the Parkland system have found that 5 to 10 percent of baby boomers test positive for the disease. And people don’t notice symptoms until the disease is advanced.

A screening program, including a navigation component to help people who test positive get the care they need, is helping to cure hepatitis C infection in the Dallas area.

“We’ve expanded our treatment capacity from one to five clinics per week, and over the past couple of years we’ve successfully treated and cured more than 1,000 patients for hepatitis C,” says Dr. Singal, who is also the Clinical Chief of Hepatology at UTSW. New drugs available to treat hepatitis C cure about 90 percent of cases.

Because medications to treat hepatitis C can be expensive, the team helps people navigate patient assistance programs. “We have been able to set up a program so underinsured patients are being cured at minimal to no out-of-pocket costs,” Dr. Singal says.

The team plans to expand the program to Tarrant and surrounding counties and to add a mobile van that can bring hepatitis C screenings to rural areas.

3. Spotting Liver Cancer Early

If liver cancer does develop, early detection can bring the five-year survival rate up to 70 percent. But the cancer is deadly at more advanced stages, with an average survival below one year at its most advanced stage.

In one study, UT Southwestern researchers used electronic medical records to identify patients who might be at higher risk for liver cancer, based on a previous diagnosis of cirrhosis. The researchers mailed letters inviting those patients to get screened for cancer with ultrasound and a blood test that is covered by insurance.

The outreach effort tripled the number of people who were screened, and the team is now expanding the invitations to 3,000 patients in three different health systems.