Researcher, CPRIT Bring ACTION to Big Country

Colorectal cancer is the third most common cancer diagnosed in Texas men and women, according to the Department of State Health Services. An increase in colorectal cancer screenings since the mid-1980s has led to fewer diagnoses, but financial concerns have prevented more individuals from accessing screening services.

For residents of Abilene, Texas, and surrounding communities, cost is not a barrier to receiving screenings, thanks to the TTUHSC ACTION (Against Colorectal Cancer Together in Our Neighborhoods) for Big Country program. Julie St. John, DrPH, MPH, an associate professor in the School of Health Professions, is the principal investigator and project director for the program, which provides education, fecal immunochemical test (FIT) screenings and colonoscopy services to uninsured or underinsured individuals.

“Colorectal cancer is the only cancer screening that can prevent cancer by removing precancerous polyps during colonoscopy,” St. John says.

ACTION for Big Country is made possible through a Prevention Program grant from the Cancer Prevention and Research Institute of Texas (CPRIT). The project serves 14 counties in the Big Country: Brown, Callahan, Coleman, Comanche, Eastland, Erath, Fisher, Haskell, Jones, Knox, Nolan, Shackelford, Stephens and Taylor.

In her role, St. John oversees all aspects of the project. She also developed the policy advocacy training curriculum for community health workers, which was submitted to the Texas Department of State Health Services for continuing education certification. 

St. John says ACTION for Big Country has three primary goals. The first is to ensure all qualified patients with abnormal screening results receive diagnostic testing and all patients diagnosed with colorectal cancer are navigated into treatment. The second goal is to decrease the burden of colorectal cancer in the ACTION priority area through appropriate screening of uninsured or underinsured adults 45 to 75 years of age.

“Finally, we want to develop training for professionals and laypeople that will increase the likelihood they will continue colorectal cancer screening even after the funding ends,” St. John says.

ACTION for Big Country team members completed 304 screening intake surveys, with 294 participants qualifying for cost-free screening from February through August 2025, the most recent six-month reporting period. Of those, 145 (49%) completed and returned their FIT tests (115 were negative; 30 were referred for treatment). In addition, 22 patients underwent colonoscopies (three more are pending), which resulted in the removal of several polyps and a diagnosis of one malignancy.

“Abilene and the Big Country area have traditionally lacked adequate and available colorectal cancer screening services,” St. John says. “That is something we are working to address through the ACTION for Big Country project.”