Oregon Health & Science University has been awarded a four-year, $3.1 million grant from the National Institutes of Health to partner with two tribal communities in Oregon on a new initiative designed to increase participation in cervical and colorectal cancer screening among American Indian and Alaska Native people.
Led by Amanda Bruegl, M.D., M.C.R., professor of obstetrics and gynecology in the OHSU School of Medicine and assistant director of community outreach and engagement at the OHSU Knight Cancer Institute, the project aims to make cancer screening more accessible by offering coordinated, home-based screening options while working closely with tribal communities to ensure the program reflects local values, priorities and needs.
The project, known as AT-HOME — American Indian/Alaska Native Tailoring of a Home-Based Cervical and Colorectal Cancer Screening Program — will focus on increasing screening rates for populations that experience disproportionately high rates of cervical and colorectal cancer, but lower participation in recommended screening programs.
“American Indian and Alaska Native communities experience higher rates of both cervical and colon cancer, and lower participation in screening programs,” Bruegl said. “The question we’re asking is: Can we increase screening participation by bringing these tests into the home setting and making them more convenient for patients?”
The study builds on OHSU’s longstanding partnerships with tribal communities, and will be conducted in collaboration with the Confederated Tribes of Warm Springs in Central Oregon and the Klamath Tribes in Southern Oregon. Researchers will also work with Papalaxsimisha, a Warm Springs nonprofit whose work is rooted in reproductive health and community wellness, to help guide project design and implementation.
Meeting communities where they are
Central to the project is its partnership with the OHSU Community Outreach, Research and Engagement team, or CORE, which connects OHSU’s established academic community outreach programs — OCTRI Community Research Hub, Knight Cancer Institute Community Outreach and Engagement, and Oregon Rural Practice-based Research Network — to transform research from a scientist-subject interaction into a collaboration.
Bruegl and colleagues developed the project with OHSU CORE after recognizing an opportunity to combine two evidence-based cancer screening approaches into a single, patient-centered program. Rather than requiring separate appointments or outreach efforts, eligible participants can receive both cervical and colorectal cancer screening kits at home and complete them at their convenience.
For participants who choose the home-based option, clinic navigators will identify those who are due for screening; coordinate mailing of screening kits; track completion; and ensure appropriate follow-up. Participants who prefer clinic-based screening will receive assistance scheduling appointments and navigating care.
“We already know that giving people a choice of how to get screened increases uptake,” said Jennifer Coury, M.A., project director for AT-HOME at Oregon Rural Practice-based Research Network. “What an amazing opportunity this will be to get at-home screening into tribal clinics just as cervical cancer home testing is getting rolled out to clinical practices across the U.S.”
Researchers hope the approach will help reach people who are overdue for screening or who have not traditionally participated in preventive care.
“At the end of the day, we just want people to screen,” Bruegl said. “We’re really interested in whether we’re reaching people who would not have participated otherwise. That’s the population we most want to engage.”
Centering community engagement
Beyond access, the project seeks to address barriers that have contributed to persistent cancer disparities in tribal communities.
These include challenges related to healthcare access, historical underinvestment in tribal health systems and longstanding mistrust of medical institutions. For some women, cervical cancer screening may also be associated with trauma because it has traditionally required an in-clinic pelvic exam, Bruegl said.
Researchers emphasize that successful cancer prevention efforts must be developed with communities, not for them.
“Different communities have different teachings and different ways of talking about health and cancer,” Bruegl said. “You have to find language and approaches that resonate with the community and align with cultural values.”
To do that, the first phase of the project will use a public health strategy known as “setting-driven design.” Community members from each tribal partner will help researchers understand how screening materials, messaging and home environments influence participation. The goal is to co-design a program that encourages people to complete screening, rather than setting aside the kits and forgetting about them.
The study will focus on adults ages 45 to 65 and aims to increase screening participation by at least 10% across participating communities. Researchers plan to enroll several hundred participants within each tribal partner community over the course of the project.
For Bruegl, who is a citizen of the Oneida Nation in Wisconsin, the work reflects the importance of partnering directly with tribal communities to develop solutions that support long-term health and wellness.
If successful, researchers hope the program could serve as a model for tribal health systems and community clinics nationwide, helping expand access to lifesaving cancer screening while reducing disparities in cancer outcomes.
This research is supported by the National Institute on Minority Health and Health Disparities of the National Institutes of Health under award number R01MD021852. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.