Cervical Cancer Prevention, the first Project ECHO program at MD Anderson, started as a partnership between MD Anderson, The University of Texas Medical Branch (UTMB), The University of Texas Health Science Center-Houston (UTHSC-H), The University of Texas School of Public Health (UTSPH) in Brownsville and Su Clinica Familiar, which is a Federally Qualified Health Center (FQHC) in the Rio Grande Valley (RGV) of Texas. The program has grown to include faculty from the UT-RGV School of Medicine and participants from Northeast Texas, Bastrop, Alvin and Laredo.
There are more than 600,000 new cases of cervical cancer and more than 340,000 related deaths annually worldwide. Greater than 85% of cases occur in low- and middle-income countries, where cervical cancer is often the 1st or 2nd leading cause of cancer death among women. It is now known that virtually all cases of cervical cancer are caused by persistent infection with high-risk types of the human papillomavirus (HPV). Preventive HPV vaccines are commercially available and are recommended for girls and boys between the ages of 11 and 12 before the onset of sexual activity yet, only 58% of adolescents in the U.S. have completed the vaccine series. Secondary prevention via cervical cancer screening, diagnosis, and treatment of women with pre-invasive cervical disease will remain necessary for the foreseeable future.
In the United States, cervical cancer incidence and mortality rates have decreased by approximately 70% over the last 70 years due to implementation of screening programs based on Papanicolaou (Pap) and more recently human papillomavirus (HPV) testing. However, medically underserved areas in the United States and globally have been unable to achieve this same success in reducing the burden of cervical cancer due to a lack of effective, high-coverage screening programs, limited public education, and a shortage of locally available trained personnel to perform the diagnostic procedures and treatments recommended for patients with abnormal screening tests.
The MD Anderson comprehensive Program for Reducing Cervical Cancer (PRCC), funded by the Cancer Prevention and Research Institute of Texas (CPRIT), employs several strategies to reduce the morbidity and mortality from cervical cancer in Medically Underserved Areas (MUA) of Texas. The program includes community outreach and education, patient navigation to improve access to services, provider hands-on training and telementoring using Project ECHO. The Project ECHO program was launched in 2014 to address high rates of cervical cancer in low-resource regions of Texas. The ECHO sessions bring together advance practice providers, nurses and physicians from underserved regions in Texas to discuss clinical guidelines and best practices for cervical cancer prevention.
The first Project ECHO program at MD Anderson, cervical cancer prevention, started as a partnership with The University of Texas Medical Branch (UTMB), The University of Texas Health Science Center-Houston (UTHSC-H), The University of Texas School of Public Health (UTSPH) Brownsville campus and Su Clinica Familiar, a Federally Qualified Health Center (FQHC) in the Rio Grande Valley. The program has grown to include faculty from the UT-RGV School of Medicine, Dell Medical School and participants from Northeast Texas, Bastrop, Alvin and Laredo.
ECHO sessions are held the 2nd and 4th Friday of the month at 7:30-8:30 a.m. central standard time (CST) via Zoom. Partners present de-identified patient cases for discussion and faculty or invited speakers present a 15-20 minute lecture on a related topic of interest. All are welcome and continued nursing and medical education (CNE and CME) credits are awarded free of charge.
- ECHO Sessions: Recurring on the second and fourth Friday of each month from 7:30-8:30 a.m. CST
|1/13/2023||Barriers to cervical cancer screening: results from a State Comprehensive Cancer Control Coalition survey in Texas||Melissa Varon, Ph.D., M.S. and Susan Parker, M.P.H.||MD Anderson Cancer Center and Baylor College of Medicine|
|1/27/2023||AIS||Andrea Milbourne, M.D.||MD Anderson Cancer Center|
|2/10/2023||HPV epidemiology||Ellen Baker, M.D., M.P.H.||MD Anderson Cancer Center|
|2/24/2023||Overview of the cervical cancer CDS software, current pilot efforts and future uptake||Mona Saraiya, M.D., MPH||Communicable Disease
|3/10/2023||The epidemic of HPV-related oropharyngeal cancer: Why we must vaccinate, but can we screen?||Erich M. Sturgis, M.D., M.P.H||Baylor College of Medicine|
|3/24/2023||Beyond the ASCCP App||Alan Waxman, M.D., M.P.H.||The University of New Mexico|
|4/14/2023||Contraception for cancer patients||Tony Ogburn, M.D.||UT Rio Grande Valley|
|4/28/2023||Current research/evidence on HPV vaccination – is one dose adequate?||Philip E. Castle, Ph.D., M.P.H.||National Cancer Institute (NCI)|
|5/12/2023||Data anaysis on vaccination, screening and treatment of preinvasive cervical cancer||Ryan Suh, Ph.D.||UT School of Public Health Houston|
|5/26/2023||Contraception in cancer pateints||Andrea Milbourne, M.D.||MD Anderson Cancer Center|
|6/9/2023||Management of HSIL||M. Yvette Williams-Brown, M.D.
||UT at Austin Dell Medical School|
|6/23/2023||Our First, Best Hope: Cancer Prevention & Healthy Lifestyles||Ernie Hawk, M.D., M.P.H.||MD Anderson Cancer Center|
|7/14/2023||The role of patient navigation in the healthcare system||Monica Pippin||MD Anderson Cancer Center|
|8/11/2023||Third party reproduction||Debbie Holman, MSN, RN||MD Anderson Cancer Center|
|8/25/2023||Clinical evaluations of breast findings||Ana Refinetti, M.D.||MD Anderson Cancer Center|
|9/8/2023||Introduction to E-cigarettes & Vaping||Lindy Upton McGee, M.D.||MD Anderson Cancer Center & Baylor College of Medicine|
|9/22/2023||Where to Biopsy||Mila Salcedo, M.D., Ph.D.||MD Anderson Cancer Center|
|10/27/2023||TBN||Ryan Suk, Ph.D.||University of Florida College of Pharmacy|
|11/10/2023||HPV Extended Genotyping: Should management differ according to viral type?”||Alan Waxman, M.D., M.P.H.||The University of New Mexico|
|12/8/2023||Offering pre-well child (9, 10, 11 and 12yo) video education about HPV||Julie Boom, M.D.||Texas Children's Hospital|
|1/12/2024||Updates in low cost technologies for cervical cancer prevention||Yajur Maker||Rice University|
|1/26/2024||Human Trafficking||Cynthia Aulds||Coalition to Combat Human Trafficking-Texas|
|2/23/2024||Follow up after treatment of a high grade lesion||Alan Waxman, M.D., M.P.H.||The University of New Mexico|
|3/8/2024||ECC Updates||Alan Waxman, M.D., M.P.H.||The University of New Mexico|
Instructions to submit new cases:
- Request the template for cases
- Fill out the template
- Send to firstname.lastname@example.org or email@example.com by Wednesday before the ECHO session
Continuing Education Credit
Instructions to obtain CME credit for attendance at the ECHO session:
- Review the following document for CME credit: CME Information/CME Disclosure Summary
- Contact Melissa Lopez Varon or Jessica Milan to get the CME evaluation links
- Complete the survey
- Instructions on Texting Attendance and Claiming Credit in PEP to obtain CME
Note: The CME Activity ID becomes active 15 minutes before the start of the session and remains active for up to 24 hours following the session.
Instructions to obtain CNE credit for attendance at the ECHO session:
The PRCC provides hands-on training for providers in MUAs in Texas. The programs are developed in collaboration with local faculty from collaborating academic organizations and are tailored to the needs of the local participating clinics and partners. The courses are offered to providers at no cost and consist of lectures to share evidence-based practices and clinical guidelines for cervical cancer screening and management of women with abnormal screening test results, followed by hands-on trainings using training models developed by Rice University bioengineering students.
Sample instruction include the following below:
Upon the conclusion of this course, participants should be able to:
- Implement best practice cervical cancer screening procedures and follow up for women with abnormal screening tests.
- Demonstrate and identify cervical conditions and lesions through colposcopy.
- Demonstrate understanding of indications, contra-indications and complications related to LEEP procedure.
- Understand when to refer patients.
Presenters (tentative) will include:
- Ellen Baker, M.D., M.P.H., The University of Texas MD Anderson Cancer Center
- Kathleen Schmeler, M.D., The University of Texas MD Anderson Cancer Center
- Mila P. Salcedo, M.D., Ph.D., The University of Texas MD Anderson Cancer Center
- Melissa Lopez Varon, Ph.D., M.S., The University of Texas MD Anderson Cancer Center
What is a patient navigator?
A patient navigator helps guide patients through the healthcare system and help them overcome barriers that prevent them from getting the care they need. Patient navigators help individuals get the health care and resources they need.
Cervical cancer is a preventable cancer yet in the United States there are about 14,100 new cases every year. Some of the highest cervical cancer incidence and mortality rates in Texas are found along the Texas-Mexico border with Hispanic women having the highest rates in cervical cancer incidence.
What we do
Our program/project aims to improve the provision of cervical cancer screening and navigation services for women residing along the Texas-Mexico border through outreach and education of the target population in conjunction with providing training, education, mentoring and support of local healthcare providers to deliver evidence-based diagnostic and treatment services.
We currently have 6 navigators supporting 25 of our collaborating clinics in the Texas area. The navigators are working to increase the number of women educated about cervical cancer screening and HPV vaccination, increase the number of women undergoing cervical cancer screening and to ensure women with abnormal test results are properly treated at our collaborating clinics.
Patient navigators at collaborating clinics perform both in-reach and out-reach activities with our target population. The navigators educate women on the importance of screening and identify women past due for their screenings and assist in making appointments and help coordinate resources as needed.
- In-reach activities are performed in participating clinics; navigators provide culturally appropriate education to women in waiting areas such as primary care and pediatric clinics.
- Out-reach activities are performed outside the clinical setting and include participation at community events, back to school events and health fairs.
Texas Public Health Regions
PHR 3: Hope Clinic
PHR 4: Genesis PrimeCare, UTHSC Tyler Clinic
PHR 5: East Texas Community Health Services, UTMB Clinic
PHR 6: Community Health Network, Pasadena Health Center
PHR 7: CommUnity Care
PHR 11: Gateway Community Health Center, UTHSC Mobile Clinic, UTMcGovern Mobile Clinic, Su Clinica, UTRGV Clinics
Please find the links below to reference relevant selected publications.
Project ECHO Bibliography *Bibliography includes overall ECHO programs, including global projects.
- Lopez MS, Baker ES, Milbourne AM, Gowen RM, Rodriguez AM, Lorenzoni C, Mwaba C, Msadabwe SC, Tavares JH, Fontes-Cintra G, Zucca-Matthes G, Callegaro-Filho D, Ramos-Martin D, Thiago de Carvalho I, Coelho R, Marques RM, Chulam T, Pontremoli-Salcedo M, Nozar F, Fiol V, Maza M, Arora S, Hawk ET, Schmeler KM. Project ECHO: A Telementoring Program for Cervical Cancer Prevention and Treatment in Low-Resource Settings. J Glob Oncol. 2016 Oct 5;3(5):658-665. doi: 10.1200/JGO.2016.005504. PMID: 29094102; PMCID: PMC5646881.
- Lopez MS, Baker ES, Maza M, Fontes-Cintra G, Lopez A, Carvajal JM, Nozar F, Fiol V, Schmeler KM. Cervical cancer prevention and treatment in Latin America. J Surg Oncol. 2017 Apr;115(5):615-618. doi: 10.1002/jso.24544. Epub 2017 Feb 7. PMID: 28168717; PMCID: PMC5990960.
- Boom K., Lopez MS., Daheri M., et al., Perspectives on Cervical Cancer Screening and Prevention in the Rio Grande Valley: Challenges Faced by Providers and Patients Along the Texas-Mexico Border. Perspect Public Health. 2019 Jul;139(4):199-205. doi: 10.1177/1757913918793443. Epub 2018 Aug 17. PMID: 30117782.
- Fokom Domgue J, Baker E, Manjuh F, Lopez M, Welty T, Schmeler KM; Cameroon Cervical Cancer Prevention ECHO collaborative group. Connecting frontline providers in Africa with distant experts to improve patients' outcomes through Project ECHO: a successful experience in Cameroon. Int J Gynecol Cancer. 2019 Nov;29(9):1446-1447. doi: 10.1136/ijgc-2019-000405. Epub 2019 May 21. PMID: 31118215.
- Varon ML, Baker E, Estrada EE, Schmeler KM, Pareja R. Advancing gynecologic oncology in Latin America through Project ECHO. Int J Gynecol Cancer. 2020 Nov;30(11):1840-1841. doi: 10.1136/ijgc-2020-001559. Epub 2020 Jun 9. PMID: 32522773.
- Phoolcharoen N, Kremzier M, Eaton V, Sarchet V, Acharya SC, Shrestha E, Carns J, Baker E, Varon ML, Karmacharya S, Aryal B, Richards-Kortum R, Salcedo MP, Schmeler KM, Pariyar J. American Society of Clinical Oncology (ASCO) Cervical Cancer Prevention Program: A Hands-On Training Course in Nepal. JCO Glob Oncol. 2021 Feb;7:204-209. doi: 10.1200/GO.20.00513. PMID: 33555914; PMCID: PMC8081534.
- Salcedo MP, Gowen R, Rodriguez AM, Fisher-Hoch S, Daheri M, Guerra L, Toscano PA, Gasca M, Morales J, Reyna-Rodriguez FE, Cavazos B, Marin E, Perez C, Guerra M, Milbourne A, Varon ML, Reininger B, Fernandez ME, Ogburn T, Castle PE, McCormick J, Baker E, Hawk E, Schmeler KM. Addressing high cervical cancer rates in the Rio Grande Valley along the Texas-Mexico border: a community-based initiative focused on education, patient navigation, and medical provider training/telementoring. Perspect Public Health. 2021 Jun 16:1757913921994610. doi: 10.1177/1757913921994610. Epub ahead of print. PMID: 34130548.
- Salcedo MP, Varon ML, Phoolcharoen N, Osman N, David E, Rangeiro R, Changule D, Andrade V, Neves A, Doughtie KM, Carns J, Lorenzoni C, Baker E, Schmeler KM. Building local capacity for cervical cancer prevention in low resource settings: Changing strategy during the COVID-19 pandemic. J Glob Health. 2021 Mar 1;11:03044. doi: 10.7189/jogh.11.03044. PMID: 33763214; PMCID: PMC7956015.
- Varon ML, Baker E, Byers E, Cirolia L, Bogler O, Bouchonville M, Schmeler K, Hariprasad R, Pramesh CS, Arora S. Project ECHO Cancer Initiative: a Tool to Improve Care and Increase Capacity Along the Continuum of Cancer Care. J Cancer Educ. 2021 Jul;36(Suppl 1):25-38. doi: 10.1007/s13187-021-02031-0. Epub 2021 Jul 22. PMID: 34292501.
- Matylevich OP, Shushkevich AB, Perevoschikov PA, Mavrichev SA, Schmeler KM. Project ECHO in Belarus: outcomes of 3-year experience. Int J Gynecol Cancer. 2021 Jun;31(6):929-931. doi: 10.1136/ijgc-2020-002284. Epub 2020 Dec 22. PMID: 33443035.
Dr. Kathleen Schmeler is a Professor in Gynecologic Oncology and Reproductive Medicine at The University of Texas MD Anderson Cancer Center. She provides care to women with gynecologic malignancies, including surgery, chemotherapy and preventive services. Dr. Schmeler is also director of the colposcopy clinics at MD Anderson and its partner public institution, Lyndon B. Johnson Hospital, where she treats women with preinvasive cervical, vulvar and vaginal diseases. Dr. Schmeler received her bachelor’s degree in mechanical engineering from Clarkson University in Potsdam, New York, before pursuing her medical degree from the Medical College of Pennsylvania–Hahnemann University School of Medicine in Philadelphia. She completed her residency in Obstetrics and Gynecology at Brown University’s Women and Infants’ Hospital of Rhode Island. She came to MD Anderson in 2004 as a fellow in Gynecologic Oncology and joined the faculty in 2007. Her research interest is in cervical cancer prevention and treatment, particularly for resource-constrained countries and for medically underserved women in the U.S. She is conducting several clinical trials Texas, Latin America and Africa. Dr. Schmeler is the past chair of the Training and Mentoring Committee of the International Gynecologic Cancer Society (IGCS) and she helps oversee the Global Curriculum and Mentoring Program, a gynecologic oncology training program for regions that do not have formalized training. The program currently has training sites in several countries in Africa, Nepal, Vietnam, the Caribbean and many other regions. Dr. Schmeler is also co-leader of the Project ECHO program. She has authored and coauthored numerous articles in peer-reviewed journals. She is an active speaker, both nationally and internationally.
Dr. Ellen Baker is the Director of Project ECHO and Cervical Cancer Prevention in the Department of Gynecologic Oncology and Reproductive Medicine at MD Anderson Cancer Center. Dr. Baker earned an MD from Cornell University and a MPH from the UT School of Public Health. After training in Internal Medicine, she joined NASA as a medical officer in 1981 and was selected as a NASA astronaut in 1984. She is a veteran of three space shuttle missions. Dr. Baker joined MD Anderson in 2014. She leads tele-mentoring programs to reach providers in underserved communities with the aim of improving access to cancer prevention and care services. She provides technical support and strategic planning for cervical cancer prevention programs, including policy, training and education and implementation of cervical cancer prevention and control programs in the US and abroad.
Dr. Mila P. Salcedo is currently an Assistant Professor in the Department of Gynecologic Oncology and Reproductive Medicine at MD Anderson Cancer Center, where she is the Director of Cervical Cancer Prevention Training and Education programs for Mozambique, Texas, and other low-resource settings. Dr. Salcedo is an Obstetrician-Gynecologist originally from Brazil. She is the former Director of the Department of Gynecology and Obstetrics at the Federal University of Health Sciences of Porto Alegre (UFCSPA) and current International Affairs Advisor for Teaching and Research at the Santa Casa Hospital in Porto Alegre, Brazil. She serves as a member of the National Committee for Diseases of the Lower Genital Tract in Brazil. Dr. Salcedo also serves as co-chair of the International Gynecological Cancer Society (IGCS) Preinvasive Program. Her main research interests are in HPV and cervical and vulvar cancer prevention.
Melissa Lopez Varon is a Program Director at MD Anderson Cancer Center. In this role, she leads the development of cervical cancer prevention training programs working closely with staff and faculty. Melissa is responsible for coordinating, planning, and implementing the Project ECHO® program at MD Anderson. Melissa oversees the Superhub for Oncology where she trains individuals from around the world to develop new Project ECHO programs that focus on cancer and cancer-related continuum of care. She also manages Project ECHO's operational activities on cervical cancer prevention and control, with a focus on populations and regions with limited resources. She works closely with local, national and international academic and public health professionals as well as community partners.
Monica Pippin is a Program Manager for the Program to Reduce Cervical Cancer. She manages the day-to-day operations and general activities, overseeing training, and supporting program navigators. Monica earned her B.S. in public health at Syracuse University in 2013. Monica first joined MD Anderson in 2018 as a supervisor for Project VALET and Project DERM in the Office of Health Policy. Before coming to MD Anderson, she worked for five years as a community health worker/navigator in the Houston area and served on the Texas Gulf Coast Community Health Workers (CHW)/Promotores Association board.
Jessica Milan is a Program Manager in The Cancer Network Global Oncology Program at MD Anderson Cancer Center. Jessica is responsible for the coordination, planning and implementation of the Project ECHO® (Extension for Community Healthcare Outcomes) programs at MD Anderson. Jessica's duties also include managing day-to-day operations and general activites to support the program. Jessica joined MD Anderson in 2013 after earning her B.S. from Midwestern State University.
Reina Guerrero is a Program Manager at MD Anderson Cancer Center. In this role, she manages daily activities and operations of research associated with the Program for Reducing Cervical Cancer (PRCC). She also coordinates the dissemination and implementation of components, interventions and materials for Project ECHO® (Extension for Community Healthcare Outcomes) Spanish speaking collaborators. Reina initially joined MD Anderson in 2014 as a Patient Services Coordinator, she has since held several different roles, wide-ranging from clinical to department operations in The Department of Gynecologic Oncology and Reproductive Medicine.
ECHO Cervical Cancer Contacts
Ellen Baker - Director, Project ECHO
Jessica Milan - Program Manager
Reina Guerrero - Program Manager
Melissa Lopez Varon - Project Director, Project ECHO
Monica Pippin - Program Manager