Clear Margins Oral Cancer Awareness

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Executive Summary

Clear Margins Oral Cancer Awareness is a nonprofit in Tennessee that provides free oral cancer screenings, early detection education and navigation to follow-up care for underserved adults in the greater Memphis metro area. Dentists and dental hygienists volunteering with the organization conduct screenings at community health fairs, community health centers, barbershops and churches, provide basic oral cancer education and connect anyone with a suspicious finding to a dental school or safety-net clinic for further evaluation within two weeks.

Oral cancer kills more than 11,000 Americans per year. Survival rates for oral cancer caught early are above 80%. For oral cancer caught late - which is the typical case - survival rates drop below 40%. The cancer is visually detectable by a trained examiner in under five minutes, yet most adults in underserved communities have never had an oral cancer screening. Tobacco use, alcohol use and HPV infection are the primary risk factors, and all three are concentrated in the population we serve. With this grant we will pay our screening coordinator and the supplies used at every event. We do not diagnose cancer. All findings are communicated in plain language and referred to a licensed provider.

What we are asking for. Our program has a Year 1 budget of about $178,000. We are asking for $48,000 from a Tennessee cancer prevention fund for screening coordinator salary and screening supplies. The rest comes from other grants and individual donors listed in the funding section. Every dollar amount in this plan is an estimate.

Company Description

Clear Margins Oral Cancer Awareness is a nonprofit organization recognized under section 501(c)(3) of the tax code, governed by a volunteer board that includes an oral surgeon, a primary care physician, a dental hygiene program director and three community members. The board meets monthly, approves the budget and oversees the executive director. A new organization without its own determination letter can use a fiscal sponsor, explained in the funding section.

What we believe. A five-minute screening that catches a cancer early is one of the most cost-effective things a person can do for their health. That screening should be available to every adult, not just those with dental insurance.

What we do:
- Free oral cancer screenings. Volunteer dentists and dental hygienists conduct visual oral examinations and velscope or similar adjunctive light screening at community events and partner sites. Each screening takes four to six minutes.
- Community education. A 15-minute oral cancer awareness presentation covers risk factors, early warning signs and the importance of regular oral screenings. Presented in English and Spanish at every event.
- Referral navigation. Adults with a suspicious finding receive a written finding summary and a phone call from the screening coordinator within 24 hours. The coordinator navigates the adult to the University of Tennessee Health Science Center dental school or a partner community health center for follow-up evaluation within two weeks.
- Tobacco cessation referrals. We connect tobacco users at every event to the Tennessee Tobacco QuitLine and distribute free cessation kits.
- Volunteer dentist and hygienist network. We recruit and train volunteer providers and coordinate their schedules for community events.

What we do not do. We do not diagnose cancer. We do not practice dentistry. All clinical work is performed by licensed volunteer dentists and hygienists operating within the scope of their Tennessee licenses. We do not share personal health information without written consent. We call 911 in any emergency.

Who we serve. Adults 18 and older in the greater Memphis metro area, with priority for adults 40 and older who use tobacco or alcohol and who have not had a dental exam in more than two years.

Our board has at least five members, including at least one person who has used our services or lives in the community we serve, and only a minority of board members may be related to each other or paid by the organization.

We keep a written conflict of interest policy, a whistleblower policy and a record retention policy, and the board reviews them every year.

Problem & Opportunity

Oral cancer is largely preventable and easily detectable early, yet most cases in our community are found late.

1. Late-stage detection is the norm. Oral cancer in the United States is diagnosed at an advanced stage in approximately 60% of cases, most commonly because no screening was performed and the person did not recognize warning signs.
2. Survival gap. Five-year survival for localized oral cancer (caught early) is about 84%. For regional spread it is about 67%. For distant spread it is about 40%. The difference between catching it early and catching it late is measured in years of life.
3. Underserved population concentration of risk factors. Tobacco use, heavy alcohol use and HPV infection - the three primary risk factors - are concentrated in lower-income communities. African Americans in the United States have significantly higher oral cancer mortality rates than white Americans, driven largely by later detection.
4. Dental care access gap. Adults without dental insurance rarely see a dentist, and general dentists - the most likely provider to perform an oral cancer screening - are not accessible to much of the Memphis metro's low-income population. A 2022 survey found that many Memphis adults had not seen a dentist in more than two years.
5. Awareness gap. Most adults have never heard of an oral cancer screening. A community survey we conducted found that most adults in the target population did not know that oral cancer could be detected visually by a trained examiner.

Why it matters now. Shelby County has one of the highest rates of oral cavity and pharyngeal cancer incidence and mortality in Tennessee. The Tennessee Department of Health has identified oral cancer as a cancer health equity priority.

How we know the need is real. We reviewed Tennessee Cancer Registry oral cancer data for Shelby County, interviewed the University of Tennessee dental school oral surgery department and talked with community health center dental directors about the frequency of late-stage referrals they receive. We conducted a community awareness survey of 90 adults. The detail is in the appendix.

Products & Services

What the funded project will do. With this grant we will pay the screening coordinator's salary and buy the supplies used at every screening event.

How an adult takes part:
1. Event. An adult arrives at a community health fair, a community health center screening day, a barbershop event or a church health ministry event.
2. Consent and education. The adult receives a brief oral cancer education handout and a volunteer provider explains the screening in plain language before it begins. Written consent is obtained.
3. Screening. A licensed dentist or dental hygienist examines the oral cavity visually and with adjunctive velscope light. The examination takes four to six minutes.
4. Finding communication. The provider communicates the finding to the adult in plain language immediately: nothing suspicious, something that should be watched, or something that should be evaluated promptly.
5. Referral. The screening coordinator follows up by phone within 24 hours for any adult with a suspicious or watchful finding, confirms an appointment at the dental school or a partner clinic and tracks whether the appointment is kept.
6. Tobacco cessation. Any tobacco user is offered a Tennessee Tobacco QuitLine referral and a free cessation kit.

What the grant pays for. This request covers the screening coordinator's salary and all supplies used at screening events.

What we do not promise. We do not promise that any finding will be cancer-free or that every referred adult will keep their follow-up appointment. We track screenings performed, suspicious findings referred, referrals kept within two weeks and tobacco cessation referrals made, and we report honestly.

Safety. All clinical work is performed by licensed providers operating within their Tennessee license scope. Findings are communicated by the provider, not by the coordinator or other staff. All personal health information is confidential. Consent is obtained in writing before every screening.

Market Analysis

Who benefits from this project are adults in the greater Memphis metro area, with a focus on adults who have not had a dental exam in more than two years.

Who we serve. Adults 18 and older in Shelby County and adjacent counties, with priority for adults 40 and older who use tobacco or alcohol and have not seen a dentist in more than two years.

How many we plan to serve. About 1,200 screenings across 30 community events in Year 1. By Year 5 we plan to perform about 2,500 screenings annually across 60 events. We chose those numbers from volunteer provider availability and the coordinator's event scheduling capacity.

Where we serve. Community health fairs, federally qualified health centers, community health centers, barbershops and church health ministry events across Shelby County and adjacent Fayette and Tipton counties.

Who else benefits. The dental school, which receives appropriate referrals for evaluation. The community health centers, which benefit from a screening program that creates informed patients. The state, which benefits from earlier detection of a preventable cancer mortality.

We choose how many events to schedule from volunteer dentist and hygienist availability and the coordinator's realistic capacity, not from the size of the need.

Competitive Landscape

Other oral cancer resources in our area.

1. University of Tennessee Health Science Center dental school. Provides oral cancer evaluation and treatment but not community screening. We refer suspicious findings to them.
2. Community health center dental programs. Provide dental care to uninsured and low-income patients but do not have capacity for community outreach screening events.
3. American Cancer Society. Provides cancer education and some community events nationally but no oral cancer-specific screening program in Memphis.
4. Private dentists. A 2022 survey found that many Memphis adults had not seen a dentist in more than two years.

What makes us different. We bring screening to community sites rather than requiring a dental appointment, we provide immediate follow-up navigation for suspicious findings, we train volunteer providers specifically for community screening events and we partner with the dental school and community health centers so every referral has a real destination.

How we avoid duplication. We coordinate with the UT dental school oral surgery department and two community health center dental programs quarterly. We do not duplicate their services; we generate appropriate referrals to them.

Marketing & Sales Strategy

How we will reach adults once the project is funded.

Community health centers. Three federally qualified health centers in Shelby County host our screening days four times a year at each site. This is our most consistent screening venue.

Church health ministries. Faith communities with active health ministries, particularly those serving African American congregations, host events and announce them to their membership.

Barbershops. Memphis barbershops serving predominantly African American male clients are a proven venue for health screening events. We partner with four barbershops whose owners have agreed to host.

Community health fairs. We participate as a screening station at six health fairs per year organized by other community organizations.

Funding cultivation. The American Cancer Society's Community Impact grant program, the Tennessee Cancer Coalition, CDC's National Program of Cancer Registries, the Tennessee Department of Health cancer prevention grants and Memphis-area health foundations are our primary funding prospects.

Annual event. A Clear Margins Awareness Luncheon each April during Oral Cancer Awareness Month raises individual donor support.

Operations Plan

How the project will be carried out.

Timeline for Year 1. Month 1: confirm event calendar, finalize volunteer provider network, order supplies. Month 2: begin event schedule. Months 2 to 12: 30 community events across the year on a scheduled calendar. Follow-up navigation for every suspicious finding within 24 hours.

Volunteer provider network. We recruit and maintain 20 to 25 licensed dentists and dental hygienists who rotate through events. Each provider is briefed on the screening protocol, the finding communication process and the referral pathways before their first event.

Supplies. Velscope or equivalent adjunctive screening light (one per event kit), disposable examination gloves, gauze, dental mirrors, tongue depressors, education handouts in English and Spanish, tobacco cessation kits and consent forms.

Partners. UT dental school oral surgery department, three federally qualified health centers, four barbershop owners, the Tennessee Tobacco QuitLine and two dental hygiene programs that recruit student volunteers. Each has a written agreement.

Money controls. Supplies are purchased quarterly in bulk. Two people approve every purchase over $300. Event expenses are documented per event.

Records and reporting. We track screenings per event, suspicious findings, referrals made, referrals kept within two weeks and tobacco cessation referrals. We report to funders twice a year.

Management & Organization

The executive director manages the organization, the volunteer network and the funder relationships. The screening coordinator manages the event calendar, the supply logistics and the follow-up navigation for every suspicious finding.

The team. Pay figures include payroll taxes and workers' compensation insurance. The numbers in parentheses are how many people we plan to have in Years 1 through 5. A number with a half, such as 2.5, means a hire phased in during the year or one part-time person.
- Executive Director: 1, 1, 1, 1, 1 (Years 1 to 5), about $62,000 a year.
- Screening Coordinator: 1, 1, 2, 2, 2 (Years 1 to 5), about $46,000 a year each.
- Program Associate (added as the budget grows): 0, 0, 0, 1, 1.5 (Years 1 to 5), about $38,000 a year each, hired as new grant money arrives.
- Volunteer Dentists and Hygienists: 20 to 25, rotating, no salary, stipend of $50 per event for mileage reimbursement.

Governance and money controls. The board reviews financials monthly. An outside accountant prepares the yearly tax return. Every grant is in its own budget line. Provider mileage stipends are paid by check and logged per event.

Feedback and complaints. Participants can give feedback to the coordinator by phone or written form after any event. We report themes to the board quarterly. No participant loses services for speaking up.

Milestones Narrative

Goals for each of the first five years. These are goals, not promises.
- Before the grant starts: confirm volunteer provider network, finalize event calendar and partner agreements, order supplies.
- Year 1: perform about 1,200 screenings at 30 events, refer 100% of suspicious findings to follow-up evaluation and track referral completion within two weeks. Budget about $178,000.
- Year 2: add a second screening coordinator and expand to 45 events. Budget about $222,000.
- Year 3: launch a Spanish-language oral cancer education module in partnership with a Memphis Latino health organization. Budget about $258,000.
- Year 4: add a mobile screening vehicle to reach more rural locations in Fayette and Tipton counties. Budget about $295,000.
- Year 5: perform about 2,500 screenings annually at 60 events. Budget about $330,000.

How we will measure results: screenings performed, suspicious findings identified, referrals made and kept within two weeks, tobacco cessation referrals and follow-up appointment completion rate. We report to funders twice a year.

Funding Request

What we are asking for, and how the money will be used. Our request: $48,000 from a Tennessee cancer prevention fund for screening coordinator salary and screening supplies, for January through December 2027.

The request is spread across these budget lines:
- Personnel: Screening Coordinator salary (part), $38,000 (other funds cover the remaining $8,000 of the coordinator's $46,000 salary).
- Other: Screening supplies - velscope units, gloves, gauze, mirrors, education handouts, cessation kits and consent forms - $10,000.

Other money in the program. This request is about 32% of Year 1 grant income. Other grants and donors pay for everything it does not cover.

Year 1 budget: about $178,000, planned to balance with a small surplus (about $3,600 after the yearly wear on equipment). Year 1 money coming in: Grant Revenue $150,000; Individual Donors and Clear Margins Luncheon $28,000. Year 1 costs: executive director $62,000; screening coordinator $46,000; volunteer provider mileage stipends ($50 per event for 30 events for 1 provider per event on average) $1,500; screening supplies $10,000; event logistics and venue costs $10,000; clear Margins Luncheon $10,000; office and reporting $10,000; program supplies, participant support and contingency $23,300.

One-time startup costs. Startup costs of $13,400 are paid once from startup funds: $4,800 for two velscope units at $2,400 each, $3,200 for laptops and a secure screening records system, $2,400 for legal setup and provider agreement review and screening protocol documentation, $1,800 for banners, event materials and a website, and $1,200 for Spanish translation of all educational materials and consent forms.

How we got our startup number. The Funding Need Calculator in this plan adds the startup costs ($13,400), the cash the program uses before it balances (about $1,900) and a cash cushion of about $43,200, which is about 3 months of Year 1 costs. In all, that comes to $59,000. We start with $16,000 of our own savings and $43,000 from the Tennessee Cancer Coalition startup grant and board contributions, $59,000 in all, which covers that amount.

The next five years. Our budget grows from about $178,000 in Year 1 to about $330,000 in Year 5. Grant revenue is planned at $150,000, $147,000, $166,000, $186,000 and $182,000 in Years 1 to 5. Other income grows as sponsors and donors join. The program plans to end each year with a surplus, about $3,600, $39,100, $19,600, $7,800 and $11,800 in Years 1 to 5, which we put into savings. Some years are larger because new grant money arrives before the added staff are hired. The lowest year-end cash in the plan is about $49,100.

After the grant. CDC National Program of Cancer Registries grants and American Cancer Society Community Impact grants become the primary revenue streams. The Clear Margins Luncheon matures into a sustainable annual event.

Risks:
- A suspicious finding referral may not be kept. We call within 24 hours, offer to schedule the appointment ourselves and call again at two weeks. We cannot force an appointment but we document every contact.
- A velscope unit may malfunction at an event. We carry one backup unit at every event and keep the second in reserve.
- Volunteer provider cancellations can leave an event understaffed. We maintain a substitute list of five providers per event date and call substitutes 48 hours in advance.
- A major grant may end. We grow the Clear Margins Luncheon and individual donors each year.

If you are just starting. A new organization can begin through a fiscal sponsor: an established nonprofit that receives grants and passes the money to your program, usually for a fee of around 5% to 10% of the grant. Starting with 10 events per year at three established community sites with a strong volunteer provider allows you to document screening outcomes and referral rates before applying for larger grants.

Appendix Notes

Documents to attach before you send this proposal:

- Your IRS determination letter showing 501(c)(3) status, or your fiscal sponsor agreement.
- Your board list and board minutes approving the application.
- Your most recent budget and financial statements.
- A list of other funders and what each has given or been asked to give.
- Volunteer dentist and hygienist license copies and signed provider agreements.
- Screening protocol document and finding communication protocol.
- UT dental school referral agreement.
- Community health center partner agreements.
- Consent form in English and Spanish.
- Velscope purchase receipt or quote.
- Community awareness survey data (90 adults, 72% unaware of oral cancer screening).
- Tennessee Cancer Registry oral cancer incidence and mortality data for Shelby County.
If you don't have any of this yet, no worries - let's continue.

The assumptions behind our numbers:
- Grant Revenue: $150,000 in Year 1, planned to reach $182,000 in Year 5.
- Individual Donors and Clear Margins Luncheon: $28,000 in Year 1, growing to $148,000 in Year 5.
- Velscope units: 2 units at $2,400 each in Year 1; replacement and additional units budgeted in Year 4.
- Screening supplies: $10,000 per year covers gloves, gauze, mirrors, printed handouts, cessation kits and consent forms for 1,200 screenings.
- Volunteer provider stipend: $50 per event per provider for mileage reimbursement; typically 1 provider per event, 30 events per year.
- Every dollar amount is an estimate.

Plain words used in this proposal:
- Velscope: a handheld light device that uses fluorescence to help a trained examiner identify tissue that may need further evaluation. Not a diagnostic device.
- Adjunctive screening: a tool used alongside a visual examination to improve the examination, not a replacement for it.
- Oral cancer: cancer occurring in the mouth, lip, tongue, floor of the mouth, gums, cheeks or throat. Sometimes called oral cavity and oropharyngeal cancer.
- FQHC: federally qualified health center, a community clinic receiving federal funding to serve uninsured and low-income patients.
- Tobacco QuitLine: a free state-run phone and text service that provides cessation coaching and free nicotine replacement therapy.
- 501(c)(3): the tax status that lets a nonprofit receive tax-deductible gifts and many grants.

Startup Costs