January 19, 2017
In the United States, cervical cancer is becoming less common thanks to increased vaccinations, improved screening rates and better treatments. But incidence and death rates remain high among women in underserved areas across the country. We talked to MD Anderson’s Kathleen M. Schmeler, M.D. about the Project ECHO program that trains community health providers to better educate, screen and treat women along the Texas-Mexico border.
Dr. Schmeler was interviewed on this topic recently by The New York Times.
Dr. Schmeler, tell us about Project ECHO.
Project ECHO was developed in 2003 by Dr. Sanjeev Arora, a hepatitis C specialist at the University of New Mexico, to improve both provider capacity and access to specialty care for rural and underserved populations. ECHO links multidisciplinary specialist teams with community primary care clinicians through videoconferencing to co-manage patient cases. During these teleECHO™ clinics, specialists share their expertise via mentoring, guidance, feedback and didactic education. This approach has enabled clinicians in medically underserved areas to develop the skills, confidence and knowledge to treat patients with common, complex diseases in their own communities, thereby reducing travel costs, wait times and avoidable complications.
What makes this project so effective in this area?
Cervical cancer is a notable example of the health disparities that persist today. Worldwide, cervical cancer is the fifth most common cancer among women. However, cervical cancer is less common in the United States. The development of the Pap test coupled with the introduction of organized screening programs has led to a 70 percent decrease in cervical cancer incidence and mortality rates during the last 60 years in the U.S. and other high-income countries. In contrast, cervical cancer remains one of the most common cancers among women in low-income countries and medically underserved areas of the U.S. due to lack of regular screening and limited access to care.
One of these areas is the Rio Grande Valley (RGV) of south Texas, located along the Texas-Mexico border. The population in this area is largely Hispanic and medically underserved. The cervical cancer incidence and mortality rates in this region are approximately 30 percent higher than the rest of Texas. These populations are less likely to receive cervical cancer screening due to economic, social, educational and geographical barriers. In addition, there is often a shortage of locally-available trained providers to perform screening tests and to manage patients with abnormal findings. Since Project ECHO brings the knowledge and resources of specialists and large institutions to underserved communities, we adopted that model to educate additional local providers on how to manage cervical dysplasia (pre-cancerous conditions) in patients in this region of Texas.
What techniques or strategies do you use when working with the community providers?
We travel to the RGV regularly for hands-on training. We will be holding the first “LOCAL” colposcopy and Loop Electrosurgical Excision Procedures (LEEP) course next month in the RGV. An important part of these projects is community outreach activities where we work with our local partners to educate the public on HPV vaccination and cervical cancer screening.
Do you think this model can work in other communities?
Absolutely. We are currently using Project ECHO in many settings including Houston, the Rio Grande Valley, Zambia and Mozambique in Africa as well as 12 countries in Latin America. It is a bit complicated with multiple time zones and different languages, but we are able to make it work!
You’ll be speaking more about cervical cancer prevention and early detection at the 2017 Dialogue for Action® conference. What are you hoping participants take away from your presentation?
Cervical cancer is a preventable disease. No woman should die of cervical cancer, yet that is what I see every day in my clinic in Houston and what happens around the world. We need to vaccinate our children against HPV and screen every woman to prevent cervical cancer. We are working hard to educate and train health care providers and policy makers to make this happen.
To learn more about Project ECHO and cervical cancer prevention in low-income areas, listen to Dr. Schmeler’s presentation at the 2017 Dialogue for Action® conference. The Prevent Cancer Foundation’s annual national conference brings together a diversity of stakeholders to discuss the best ways to reinforce cancer screening, prevention and risk reduction initiatives in their communities. Learn more about the Dialogue for Action® conference, its speakers and presentation topics.