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Background Occupational exposure to agrochemicals, some of which are known or suspected carcinogens, is a major health hazard for subsistence agricultural workers and their families. These impacts are more prevalent in low-and-middle income countries (LMIC) due to weak regulations, lack of awareness of the risks of contamination, predominant use of handheld backpack style spraying equipment, general lack of personal protective equipment (PPE), and low literacy about proper agrochemical application techniques. Reducing exposure to agrochemicals was identified as a paramount concern by rural Hondurans working with a community-engaged research initiative. Fluorescent tracer dyes have been described as a means of visualizing and quantifying dermal exposure to agricultural chemicals, and exposure models adapted for LMIC have been developed previously. Tracer dyes have also been used in educational simulations to promote pesticide safety. However, studies evaluating the effectiveness of these educational dye interventions in reducing future exposure have been lacking. Aim To evaluate whether observing one's own chemical contamination after applying agrochemicals changed the amount of occupational dermal exposure during a subsequent chemical application. Methods We employed a multi-modal community intervention in a rural village in Honduras that incorporated chemical safety education and use of a fluorescent tracer dye during pesticide application on two consecutive occasions, and compared dermal exposure between the intervention group (previous dye experience and safety education, n = 6) and the control group (safety education only, n = 7). Results Mean total visual score (TVS) of the tracer dye, which accounts for both extent and intensity of whole-body contamination, was lower among those who had previously experienced the dye intervention (mean TVS = 41.3) than among participants who were dye-naive (mean TVS = 78.4), with a difference between means of −37.10 (95% CI [-66.26, −7.95], p = 0.02). Stratifying by body part, contamination was significantly lower for the anterior left lower extremity and bilateral feet for the dye-experienced group vs. dye-naive, with most other segments showing a trend toward decreased contamination as well. Conclusion Participants who had previously experienced the dye intervention were significantly less contaminated than the dye-naive control group during a subsequent spraying event. The findings of this small pilot study suggest that a multi-modal, community-based approach that utilizes fluorescence-augmented contamination for individualized learning (FACIL) may be effective in reducing dermal exposure to carcinogenic agrochemicals among subsistence farmers in Honduras and other LMIC.

Evidence-based interventions often need to be adapted to maximize their implementation potential in low-to middle-income countries. A single-arm feasibility study was conducted to determine the feasibility and acceptability of a telephone-delivered, nurse-led, symptom management intervention for adults undergoing chemotherapy in Honduras. Over the course of 6 months, nurses engaged 25 patients undergoing chemotherapy in the intervention. Each participant received an average of 16.2 attempts to contact them for telephone sessions ( SD = 8.0, range = 2-28). Collectively, the participants discussed 24 different types of symptoms. The most commonly discussed symptoms were pain (12%), nausea (7%), and constipation (5%). Qualitative and quantitative data were used to identify treatment manual modifications (i.e., adding content about different symptoms and addressing scheduling of treatment) and workplace modifications (i.e., dedicated nurse time and space) that are needed to optimize implementation of the intervention.

PURPOSE To evaluate the feasibility of brigade-style, multiphasic cancer screening in Honduras, exploring data from 3 screening events that each tested for multiple cancers on single occasions. METHODS This series of 3 studies each used a single-arm, post-test–only design to explore the feasibility of implementing multiphasic, community-based cancer screening at the same rural location in 2013, 2016, and 2017. The 2013 event for women screened for 2 cancers (breast and cervix), and the 2016 event for women screened for 3 cancers (breast, cervix, and thyroid). The 2017 event for men screened for 5 cancers (skin, prostate, colorectal, oropharynx, and testes). RESULTS Totals of 473 and 401 women participated in the 2013 and 2016 events, respectively, and 301 men participated in the 2017 event. Staffing for each event varied from 33 to 44 people and relied primarily on in-country medical students and local community members. High rates (mean, 88%) of compliance with referral for follow-up testing at clinics and primary care facilities were observed after the screening events. CONCLUSION The multiphasic, community-based approach proved feasible for both women and men and resulted in high rates of compliance with follow-up testing. This approach appears highly replicable: it was conducted multiple times across the years with different screening targets, which could be further scaled elsewhere using the same technique.

Purpose Cervical cancer is a leading cause of cancer-related mortality in low- and middle-income countries (LMICs) and screening in LMICs is extremely limited. We aimed to implement on-site high-risk human papillomavirus (hrHPV) DNA testing in cohorts of women from an urban factory and from a rural village. Methods A total of 802 women were recruited for this study in partnership with La Liga Contra el Cancer through the establishment of women’s health resource fairs at two locations in Honduras: a textile factory (n = 401) in the city of San Pedro Sula and the rural village of El Rosario (n = 401) in Yoro. Participants received a routine cervical examination during which three sterile cytobrushes were used to collect cervical samples for testing. hrHPV genotyping was performed using a hrHPV genotyping assay and a real-time polymerase chain reaction instrument. Results hrHPV status across all participants at both sites was 13% hrHPV positive and 67% hrHPV negative. When hrHPV status was compared across all three testing sites, hrHPV-positive rates were approximately equal among the factory (13%), village (12%), and confirmatory testing at Dartmouth-Hitchcock Medical Center (Lebanon, NH; 14%). hrHPV genotype was compared across sites, with HPV16 showing the highest infection rate (15%), followed by HPV59 (12%), and HPV68 (11%). There was a low prevalence of HPV18 observed in both populations compared with the hrHPV-positive population in the United States. Conclusion In collaboration with oncologists and pathologists from La Liga Contra el Cancer, we were able to provide a continuum of care once health-fair testing was performed. We established a method and implementation plan for hrHPV testing that is sustainable in LMICs.

PURPOSE Low- and middle-income countries have high incidences of cervical cancer linked to human papillomavirus (HPV), and without resources for cancer screenings these countries bear 85% of all cervical cancer cases. To address some of these needs, brigade-style screening combined with sensitive polymerase chain reaction–based HPV testing to detect common high-risk HPV genotypes may be necessary. METHODS We deployed an inexpensive DNA extraction technique and a real-time polymerase chain reaction–based HPV genotyping assay, as well as Papanicolaou testing, in a factory in San Pedro Sula, Honduras, where 1,732 women were screened for cervical cancer. RESULTS We found that 28% of participants were positive for high-risk HPV, with 26% of HPV-positive participants having more than one HPV infection. Moreover, the most common HPV genotypes detected were different than those routinely found in the United States. CONCLUSION This work demonstrates a deployable protocol for HPV screening in low- and middle-income countries with limited resources to perform cytopathology assessment of Pap smears.

Purpose In Honduras, the breast cancer burden is high, and access to women’s health services is low. This project tested the connection of community-based breast cancer detection with clinical diagnosis and treatment in a tightly linked and quickly facilitated format. Methods The Norris Cotton Cancer Center at Dartmouth College partnered with the Honduran cancer hospital La Liga Contra el Cancer to expand a cervical cancer screening program, which included self-breast exam (SBE) education and clinical breast exams (CBEs), to assess patient attitudes about and uptake of breast cancer education and screening services. The cervical cancer screening event was held in Honduras in 2013; 476 women from 31 villages attended. Results Half of the women attending elected to receive a CBE; most had concerns about lactation. Clinicians referred 12 women with abnormal CBEs to La Liga Contra el Cancer for additional evaluation at no cost. All referred patients were compliant with the recommendation and received follow-up care. One abnormal follow-up mammogram/ultrasound result was negative on biopsy. One woman with an aggressive phyllodes tumor had a mastectomy within 60 days. Multimodal education about breast cancer screening maximized delivery of women’s health services in a low-tech rural setting. Conclusion The addition of opportunistic breast cancer education and screening to a cervical cancer screening event resulted in high uptake of services at low additional cost to program sponsors. Such novel strategies to maximize delivery of women’s health services in low-resource settings, where there is no access to mammography, may result in earlier detection of breast cancer. Close follow-up of positive results with referral to appropriate treatment is essential.

Real-world conditions test effectiveness, the next step after establishing efficacy in controlled settings. From the annual flu shot to HPV vaccination, effectiveness measures what happens when best efforts for vaccine development meet the realities of challenging viruses and changing subtypes in regions around the world. After testing 2,645 women from multiple locations in Honduras for types of high-risk HPV (hrHPV) and finding the prevalence of virus types to be quite different from those in the US, we asked what vaccine would be the most efficacious for the local situation, and which hrHPV types are most commonly found in cervical cancer tissues from Honduran women.

Introduction. Cervical cancer is almost always a result of infection with a high risk human papillomavirus (hrHPV) of which there are 14 different types. This type of cancer is prevalent in low- and middle-income countries (LMICs) where screening programs for pre- or invasive cervical cancer by Pap test or visual inspection with ascetic acid are limited in scope as is local expertise in evaluating Pap smears. Since 2006, a HPV vaccine protecting against hrHPV types 16 and 18 has been recommended by the WHO, and through the GAVI Alliance, is provided to some fractions of populations in more than 70 countries. A newer and more expensive vaccine protects again 9 types of HPV A broader spectrum 9-valent vaccine released in 2014 protects against HPV types 6, 11, 16, 18, 31, 33, 45, 52, and 58. Preventing cervical cancer by vaccination against HPV is considered to be a promising strategy. Materials and Methods. In three separate studies, we implemented molecular screening for hrHPV from cervical swab specimens, providing access to pre-cancer testing for women from several regions of Honduras, which is ranked the poorest country in the northern hemisphere. We screened 2,645 women from two rural regions and an urban region of Honduras. In the final study of 1725 Honduran factory workers, we substituted a large-capacity rice cooker for a standard laboratory hotplate to accelerate laboratory throughput for DNA extraction. A DNA-based multi-color melt curve analysis by PCR followed, and we were able to rapidly screen for all 14 hrHPV types. Results. Across all three studies, there was an average hrHPV positivity prevalence of 22%. The most common types of hrHPV found in each study were as follows: Study 1 hrHPV types 16, 31, 58, 59, and 68; Study 2 hrHPV types 16, 39, 52, 58, and 68; and Study 3 were hrHPV types 16, 35, 58, 63, and 64 were the most common. Among those infected with a hrHPV type, 18% had co-infections with multiple hrHPV types. Based on these results, the vast majority of infected women would not have been protected by the divalent HPV vaccine and a significant proportion of women would still not be protected by the multivalent vaccine, which does not cover the hrHPV types 35, 39, 52, 59, 63, 64, 88 found in these samples. Conclusions. Cervical cancer remains a prevalent and deadly disease in LMICs. Our studies examining the prevalence of hrHPV types in several different regions of Honduras identified high prevalence rates of viral types not targeted by commercially available vaccines. These findings suggest that vaccination programs alone should not be considered complete coverage against cervical cancer-causing high-risk HPV, and that further location-specific testing of cervical tissue for hrHPV typing is warranted. Citation Format: Aaron E Atkinson, Carlos Alberto Matute Mandujano, Suyapa Bejarano, Linda S Kennedy, Gregory J Tsongalis. High-risk HPV screening and typing shows high co-infection rate and potential for low vaccine coverage in a low- and middle-income country [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C116.

Cervical cancer rates in low- and middle-income countries (LMICs) are higher than in developed countries and account for 80% of an estimated 500,000 new cases annually. Factors that contribute to this are that diagnostic and prevention strategies designed for developed countries suffer from the combination of low vaccination rates and limitations due to lack of consistent access to both healthcare and supplies. Here we: 1) improve upon our LMIC deployable HPV test and 2) determine both the high and low-risk HPV genotype prevalence in an isolated Honduran population. We found an unexpected HPV distribution with an abundance of HPV 52 and HPV 72 infections. In this context, molecular testing using a LMIC deployable approach for the detection of HPV can aid in both the triage of HPV positive cytology-based follow up and provide information regarding HPV genotype distribution in support of vaccination strategies.

Background: Cervical cancer is one of the most prevalent cancers in Honduran women. Lacking national or population-based registries, we rely on hospital registries to establish incidence: San Felipe General Hospital in 2012 diagnosed 38% of 998 women and The League against Cancer Hospital (LCC) in 2016 diagnosed 54.4% of 695 women with cervical cancer CC. According to PAHO's Honduras Profile 2013, screening coverage with Pap was 48.1%. Bruni in 2010 reported a prevalence of high risk HPV (hrHPV) infection for Central America of 13%, identifying genotypes 16, 18, 52, 31 and 58 as most frequent. Information about pathogenesis of hrHPV to induce cervical lesions is based on models of genotypes 16 and 18 only. Aim: Inform evidence of hrHPV genotypes collected in Honduras from an urban and a rural population, generate discussion and subsequent improvement of cervical cancer control strategies in our country. Methods: In 2016, 2 clinical studies funded by Norris Cotton Cancer Center at Dartmouth College and the LCC accrued 913 women: 401 in Locomapa Valley (rural), 111 in La Mosquitia (remote rural), and 401 in a textile factory in San Pedro Sula (urban). Women were consented, to obtain 3 cervical samples, during a cervical cancer screening brigade. One sample for conventional cytology, and 2 for hrHPV by PCR genotyping. One local with our customized PCR device and the second at Dartmouth. An educational component and survey were included. Positive patients identified with hrHPV, pre or invasive cancer were referred to LCC for treatment and follow-up. Results: In Locomapa and the factory (rural and urban sites) 13% of participants were positive for hrHPV. Only 15% had HPV 16. The following common genotypes varied by location: urban factory HPV 59, 12% in rural location HPV 58, 10%; HPV 31, 9%; HPV 39 8%; HPV 35 and 66, 7%; HPV 45 and 51, 6%; HPV 18 and 56, 3%; HPV 33 and 52, 1%. 17% of women had multiple hrHPV coinfection. 7.7% had abnormal Pap tests. In La Mosquitia (remote rural), 24% of women were positive for hrHPV: HPV 52, 29%; HPV 16, 23%; HPV 39, 10%; HPV 68, 6%; HPV 58, 6%; HPV 45, 6%; HPV 51 and HPV 31, 18, 66, 59 and 35, 3% each. 1.8% had abnormal Pap tests; all participants identified with hrHPV were referred for follow-up. The average age was 40.3 years, parity, 3 children, education 6.0 years; and 15% were first-time users of a cervical screening program. Conclusion: Associate the burden of disease, with risk factors, will help us to generate models of prevention and care that are reproducible and effective to reduce morbi-mortality. Brigade-type screening models, with trained providers working at a community location over a single day, can offer improved access for women at risk and facilitate educational activities for health promotion. Introducing tests as hrHPV DNA detection, effectively reduces the volume of women to follow. Strengthening the capacity of primary care with novel screening techniques and ensure diligent follow-up is essential.

Background: Poverty, poor healthcare infrastructure and geographic location contribute to a total lack of cancer screening for most residents of rural Honduras. Three projects built upon each other to develop, with local leaders, multiorgan screening events that mitigated barriers to screening-based early detection of cancers. Targeted barriers included transportation, cost, community perception and convenience. Aim: To test a novel system of multiorgan screening for feasibility, acceptability and effectiveness. Methods: Leveraging well-known brigade-style medical outreach methods, two large-scale weekend programs for women and one for men over four years in the same rural location screened women for cancers of the cervix, breast, oral cavity, thyroid; and men for cancers of the testes, oral cavity, skin, prostate and colon; and connected participants with follow-up care at a Honduran cancer center. Screening methods ranged from simple throat palpation for thyroid lesions to molecular screening for high risk HPV. Generally, screening began with low-tech methods onsite to triage the participants and identify those at high-risk for cancer who should have more technical follow-up at an equipped clinic. Well-trained Honduran medical students provided screening capacity and community leaders were solely responsible for promoting the screening opportunities. Masking was not possible onsite, but data analysis in the U.S. was anonymized. Results: Participants were accrued to each program's capacity (n=400) in 2013 and 2016 and near capacity in 2017 with high levels of participants completing the screening programs, community engagement with the process, and compliance with referrals for clinical follow-up at a collaborating cancer center located three hours away. Participants identified at the screenings for clinical follow-up included for women: breast 2.7% (2013) and 4.2% (2016), thyroid 1.7% (2016), cervix/positive for high risk HPV 8.2% (2013) and 11.8% (2016); and for men all in 2017: skin 0%, testes 7%, colorectal 1%, oropharynx 1 participant, and prostate 6.7%. The dominant local narrative predicted men would not participate in screening, yet 326 participated and of that group, 239 self-identified as having possible colorectal symptoms based on seeing an advertising flyer with questions about symptoms of constipation, bloody stools, or unintended weight loss. That self-identified subset took the initiative to see the local nurse in advance, obtain a colorectal sample kit, collect three days of stool samples, and bring them to the screening event. Conclusion: With community engagement and attention to planning for organized and rapid throughput, large-scale multiorgan cancer screening may be feasible in low-income rural communities. Funding: The Jornada studies were funded by Norris Cotton Cancer Center at Dartmouth's Geisel School of Medicine and a special grant from Geisel's Munck-Pfefferkorn Fund.

Background: Occupational exposure to agrochemicals, some of which are known or suspected carcinogens, is a major health hazard for subsistence agricultural workers and their families. These impacts are more prevalent in low-and-middle income countries (LMICs) due to weak regulations, lack of awareness of the risks of contamination, general lack of personal protective equipment (PPE), and low literacy about proper agrochemical application techniques. Fluorescent tracer dyes have been described as a means of visualizing and quantifying dermal exposure to agricultural chemicals, and dye techniques adapted for LMICs have been developed previously. These tracer dyes have also been used in educational demonstrations about pesticide safety. However, studies evaluating the efficacy of these educational dye interventions in reducing exposure have been lacking. Aim: To evaluate whether observing one's own chemical contamination after applying agrochemicals changed the amount of occupational dermal exposure during a subsequent chemical application. Methods: We used a multimodal community intervention in a rural village in Honduras that incorporated chemical safety education and use of a fluorescent tracer dye during pesticide application and compared dermal exposure between the intervention group (previous dye experience and safety education) and the control group (safety education only). Results: Mean total visual score (TVS) of the tracer dye, which accounts for both extent and intensity of contamination, was lower among those who had previously experienced the dye intervention (mean TVS=41.3) than among participants who were dye-naïve (mean TVS=78.4), with a difference between means of -37.10 (95% CI [-66.26, -7.95], P = 0.02). Conclusion: That workers who had experienced the dye demonstration once before were significantly less contaminated on average when compared with the dye-naïve group indicates that a multimodal community intervention that utilizes fluorescent dye visualization may be effective in reducing dermal exposure to carcinogenic agrochemicals among subsistence farmers in LMICs.

Introduction: Poverty, poor health infrastructure, and rurality contribute to lack of cancer screening for most residents of Honduras (HN). We hypothesized that if community-identified barriers were mitigated, rural Hondurans would participate in cancer screening; initial low-tech screening methods would be useful in identifying high-risk individuals in a large group; and that we could operationalize an acceptable and effective multiorgan screening program. Our objective was to test multiorgan cancer-screening strategies for challenging rural environments such as our site in rural El Rosario, Honduras and develop a strategy that would be generalizable to rural sites in other low-income countries. Methods: We conducted three cancer-screening projects (2013/n=449 women, 2016/n=389 women, 2017/n=299 men) by developing relationships with rural community leaders and Honduran oncologists. Together, we launched multiorgan screening events via a brigade-style medical outreach model designed to mitigate barriers to early detection of cancers. Key strategies: 1) a screening cascade system and low-tech methods to identify high-risk individuals for further screening; 2) triage for findings requiring additional workup, rather than focusing on making a definitive cancer diagnosis; 3) inserting cancer education into the participants' experience; and 4) multiorgan screening to maximize cancer prevention with little additional use of resources. Community-identified barriers were transportation, cost, fear, and inconvenience; we negotiated an array of minimalist and highly effective community-based strategies to mitigate the barriers. In 2013 and 2016 we screened women for cancers including cervix, breast, oropharynx, and thyroid, and in 2017 screened men for testicular, oropharynx, skin, prostate, and colon cancers. Post-study, participants with suspicious findings were connected with follow-up care at a cancer center in HN. On-site screening methods ranged from no-tech, including surveys, clinical breast exams, throat palpation for thyroid, digital rectal exam for prostate, physical exam of testes, and visual skin inspection for skin cancer; to mid-tech, including telepathology for oral cancer, fecal occult blood test for colon cancer, and PSA for prostate; and high-tech PCR screening for high-risk HPV (hrHPV). Well-trained HN medical students staffed the screening areas; their participation is intended to increase long-term screening capacity in HN. Community leaders were responsible for promoting the screening clinic by training teens who traveled to villages to introduce the opportunity. Results: Participants came via a free bus, horse, motorbike, and on foot from 31 (2013), 40 (2016), and 38 (2017) different communities. Median age and years of education were 38/5 (2013), 40/6 (2016), and 47/4 (2017). Almost every participant completed all screenings. We found 11 types of hrHPV; in 2013/8.4% and 2016/12.5% were positive for 1 or more types. Referrals for breast follow-up were 2013/2.7% and 2016/4.4%. In 2017 (men), 26 referrals were: skin screening/2; testicular exams/2; colon/2; oropharynx/0; and 20 men for clinical prostate follow-up by a screening cascade of survey, digital rectal exam, and PSA. 249 men self-identified based on ASCO colon standards and brought stool samples for FOBT/4 tested positive. We used oral consent and focus groups for post-event evaluation. Comments reflected satisfaction with the medical students, convenience of a free bus, and protection of participants' privacy. Conclusion: With community engagement and attention to planning for organized and rapid throughput, large-scale multiorgan cancer screening is feasible in low-income rural communities. Despite low expectation of male participation because it is “common knowledge” that Honduran males avoid clinics, our experience demonstrates that with mitigation of barriers, men will participate. Citation Format: Linda Skewes Kennedy, Kayla A. Marra, Ethan Phillip Marshall LaRochelle, Mary D. Chamberlin, Kathleen D. Lyons, Suyapa A. Bejarano, Gregory J. Tsongalis. Cancer screening in rural Honduras: Maximizing impact with a multiorgan screening approach [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr B20.

Objective: Lack of newborn screening, limited access to healthcare, and complex presentation has resulted in gross under-diagnosis of in-born metabolism disorders in many Central American countries. In this study we describe the use of advanced clinical genomics to identify a novel cystathionine-beta-synthase (CBS) mutation with limited clinical information from a small highly consanguineous indigenous community in rural Honduras. Methods: We performed chromosomal microarray analysis and whole exome sequencing on three affected siblings and their mother. Confirmatory Sanger sequencing for CBS exon 10 was performed on genomic DNA from extended family within the community. Results: We identified a novel homozygous missense mutation (p.Tyr308Thrfs*11) in CBS that resulted in the diagnosis of homocystinuria in three siblings. Patients were nonresponsive to standard pyridoxine treatment. We discovered an elevated coefficient of inbreeding (F ≥ 0.20) suggestive of an unreported highly consanguineous population. Genotyping identified ~47% of extended family as carriers of this novel mutation. Conclusion: Expanded use of whole exome sequencing from buccal cell genomic DNA allowed for the discovery of a novel mutation resulting in a rare recessive disorder in an isolated under-served population. Clinical phenotypes and treatment response of patients with this novel homozygous mutation add to our clinical understanding of homocystinuria.

Abstract 36 Background: Women in rural Honduras have limited access to cancer education, screening, and care. With village leaders, we piloted breast and cervical cancer screening in El Rosario, Honduras. Our objectives were to improve awareness and access, mitigate barriers, connect community and Honduran providers, and link patients with abnormal findings to cancer treatment. In 2013, health professionals and staff from Norris Cotton Cancer Center at Dartmouth- Hitchcock joined Honduran clinicians and medical students from La Liga Contra el Cáncer for two days of rural cancer screening. Peer educators taught 475 participants from 31 rural communities how to conduct self-breast exams. Of these participants, 238 chose clinical breast exams; 5% were clinically abnormal and 2.9% were referred for services at La Liga with 100% compliance. 34% reported barriers to cervical cancer screening due to distance and lack of transportation. 14.5% tested positive for HPV and 8% were positive for high risk HPV genotypes including 11 of 13 known high risk types. This group has been retested periodically by Pap. The collaborators will return in April 2016 to repeat the study, adding oral and thyroid screening. Genotyping for hrHPV will be onsite with a novel assay for PCR developed at Dartmouth-Hitchcock. Reflex testing with Pap will follow as needed. Follow up will be at La Liga where care is offered for free or at a reduced cost. A similar project for 400 urban factory-workers will also take place in April 2016. Methods: 2-day, multi-modal education and screening outreach run brigade-style combining low-tech primary screening with onsite molecular pathology. Conclusions: Partnerships between local leaders and clinicians are predicted to be essential to project implementation. Targeting populations with education and screening plus building connections to follow up care will provide earlier detection of breast and cervical cancer. We predict that community leadership will be critical to preventing loss to follow-up. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST: Derek S. Stenquist No relationship to disclose Suyapa Bejarano No relationship to disclose Linda S. Kennedy No relationship to disclose Silvia Portillo No relationship to disclose Ana Barrientos No relationship to disclose Suzanne P. Burgos No relationship to disclose Roberto Armando Elvir Zelaya No relationship to disclose Christine Averill No relationship to disclose Emmeline Liu No relationship to disclose Francine de Abreau No relationship to disclose Paul Burchard No relationship to disclose Torrey Gallagher No relationship to disclose Martha Goodrich No relationship to disclose Scottie Eliassen No relationship to disclose Julie Weiss No relationship to disclose Camilo Mandujano No relationship to disclose Jennifer Alford-Teaster No relationship to disclose Gregory J. Tsongalis Research Funding: Illumina, Qiagen, Thermofisher Tracy Onega No relationship to disclose Mary D. Chamberlin No relationship to disclose