Effectiveness of Interventions to Increase Screening for Breast, Cervical, and Colorectal Cancers Nine Updated Systematic Reviews for the Guide to Community Preventive Services

Context: Screening reduces mortality from breast, cervical, and colorectal cancers. The Guide to Community Preventive Services previously conducted systematic reviews on the effectiveness of 11 interventions to increase screening for these cancers. This article presents results of updated systematic reviews for nine of these interventions. Evidence acquisition: Five databases were searched for studies published during January 2004–October 2008. Studies had to (1) be a primary investigation of one or more intervention category; (2) be conducted in a country with a high-income economy; (3) provide information on at least one cancer screening outcome of interest; and (4) include screening use prior to intervention implementation or a concurrent group unexposed to the intervention category of interest. Forty-fıve studies were included in the reviews. Evidence synthesis: Recommendations were added for one-on-one education to increase screening with fecal occult blood testing (FOBT) and group education to increase mammography screening. Strength of evidence for client reminder interventions to increase FOBT screening was upgraded from suffıcient to strong. Previous fındings and recommendations for reducing out-of-pocket costs (breast cancer screening); provider assessment and feedback (breast, cervical, and FOBT screening); one-on-one education and client reminders (breast and cervical cancer screening); and reducing structural barriers (breast cancer and FOBT screening) were reaffırmed or unchanged. Evidence remains insuffıcient t

Breast, colon, and prostate screening in the adult population of Croatia: does rural origin matter?

INTRODUCTION: The aim of this study was to investigate the utilization of breast, colon and prostate cancer screening in the adult Croatian population in a period without national cancer screening programs, with a special interest in respondents' rural versus urban origin. ----- METHODS: Self-reported screening utilization was investigated in the Croatian Adult Health Survey, which collected health-related information from a representative sample of the adult Croatian population. Breast cancer screening was investigated in women aged over 40 years, while colon and prostate screening was investigated in respondents aged over 50 years. The data were analysed using binary logistic regression. ----- RESULTS: One in five women reported breast cancer screening uptake in the year preceding the survey (22.5%), while only 4.5% reported a colon screening. A total of 6.1% men reported colon screening, while 13.7% of men reported having a prostate cancer screening. Respondents with rural origin reported all sites screening utilization less frequently than those of urban origin (breast: 14.5% vs 27.4%; prostate: 9.6% vs 16.3%; colon-men: 5.7% vs 6.3%; colon-women: 3.6% vs 5.1%; respectively). Multivariable models indicated that people with higher socio-economic status more commonly reported breast and prostate cancer screening uptake. Access to health care was the only independent variable associated with colon cancer screening in men, and the strongest variable associated with colon cancer screening in women. Rural origin was associated only with lower odds of breast screening (adjusted odds ratio 0.60 [95% confidence interval 0.48-0.74]), while in the remaining models, rural origin was not a significant predictor for cancer screening uptake. ----- CONCLUSIONS: Opportunistic cancer screening uptake is low in the Croatian adult population, with existing socio-economic differences in breast and prostate screening, and their absence in colon cancer screening. Rural origin was significantly associated with breast screening, even after adjustment to socioeconomic status and problems in access to health care. Lack of rural origin significance in the other screening sites could be related to small sample sizes of people who reported opportunistic utilization. Overall, access to health care is the strongest cancer screening predictor, and this should have a prominent role in the development of a systematic cancer screening program on a national level

Barriers to cervical screening participation in high-risk women

Aim Women aged 25–35 years, for whom cervical cancer is most problematic, are least likely to participate in the cervical screening programme. Therefore, identifying barriers to screening participation in this high-risk group is essential. Subject and methods A sample of 430 women completed an electronic survey of their cervical screening history and answered questions on sociodemographic, behavioural, attitudinal and informational barriers to cervical screening uptake. Logistic regression was used to predict cervical screening non attendance. Results Women with more than 10 sexual partners in their lifetime were more likely, but women from ethnic minorities, less likely to participate in the cervical screening programme. Women unaware of the recommended screening interval were also less likely to be screened, as were women who believed that screening is a test for cancer. Screening was also less likely among women who endorsed the belief that screening in the absence of symptoms is unnecessary. Conclusion These data highlight poor knowledge of the recommended screening interval and purpose of cervical cancer screening in this high-risk group. As such, interventions that target these informational barriers might be most effective for increasing cervical screening uptake in this high-risk group

Key performance indicators for the National Bowel Cancer Screening Program: technical report

Provides a summary of the development process and the technical specification for the 11 agreed performance indicators that are part of the National Bowel Cancer Screening Program Performance Indicator Set. Summary Cancer contributes significantly to the burden of illness in the Australian community. Bowel cancer is one of the most significant cancer types in terms of incidence and mortality. In 2010, 14,860 people were diagnosed with bowel cancer and in 2011 there were 3,999 deaths from the disease. Screening for bowel cancer is available in Australia through the National Bowel Cancer Screening Program (NBCSP), which aims to reduce the incidence, illness and mortality related to bowel cancer through screening to detect cancers and pre-cancerous lesions in their early stages, when treatment is most successful. Reporting statistics about the NBCSP in a standardised way is vital to ensure that governments, researchers and health workers have access to relevant and reliable statistics about the performance of the program over time. This report describes the National Bowel Cancer Screening Program Performance Indicator Set (NBCSP PIs) and is a reference tool for anyone who wishes to understand, measure and report the progress of bowel cancer screening in Australia. The indicators were developed by the National Bowel Cancer Screening Program Report and Indicator Working Group (the working group) and have been endorsed by the Standing Committee on Screening, the Community Care and Population Health Principal Committee, the National Health Information Standards and Statistics Committee and the National Health Information and Performance Principal Committee. The indicators are consistent with the five Australian Population Based Screening Framework (PBSF) steps of recruitment, screening, assessment, diagnosis and outcomes

PreView: a Randomized Trial of a Multi-site Intervention in Diverse Primary Care to Increase Rates of Age-Appropriate Cancer Screening.

BackgroundWomen aged 50-70 should receive breast, cervical (until age 65), and colorectal cancer (CRC) screening; men aged 50-70 should receive CRC screening and should discuss prostate cancer screening (PSA). PreView, an interactive, individually tailored Video Doctor Plus Provider Alert Intervention, adresses all cancers for which average risk 50-70-year-old individuals are due for screening or screening discussion.MethodsWe conducted a randomized controlled trial in 6 clinical sites. Participants were randomized to PreView or a video about healthy lifestyle. Intervention group participants completed PreView before their appointment and their clinicians received a "Provider Alert." Primary outcomes were receipt of mammography, Pap tests (with or without HPV testing), CRC screening (FIT in last year or colonoscopy in last 10 years), and PSA screening discussion. Additional outcomes included breast, cervical, and CRC screening discussion.ResultsA total of 508 individuals participated, 257 in the control group and 251 in the intervention group. Screening rates were relatively high at baseline. Compared with baseline screening rates, there was no significant increase in mammography or Pap smear screening, and a nonsignificant increase (18% vs 12%) in CRC screening. Intervention participants reported a higher rate of PSA discussion than did control participants (58% vs 36%: P < 0.01). Similar increases were seen in discussions about mammography, cervical cancer, and CRC screening.ConclusionIn clinics with relatively high overall screening rates at baseline, PreView did not result in significant increases in breast, cervical, or CRC screening. PreView led to an increase in PSA screening discussion. Clinician-patient discussion of all cancer screenings significantly increased, suggesting that interventions like PreView may be most useful when discussion of the pros and cons of screening is recommended and/or with patients reluctant to undergo screening. Future research should investigate PreView's impact on those who are hesitant or reluctant to undergo screening.Trial registrationClinicalTrials.gov: NCT02264782

Breast Cancer Screening in Racialized Women: Implications for Health Equity

Inequalities across the breast cancer continuum due to racialization have significantly affected women's access to screening programs, diagnosis, treatment and survival. To ensure there is equitable access to quality care there needs to be a better understanding of broader systemic issues. Despite the existence of breast cancer prevention strategies across Canada, inequitable access to screening has barred many women from receiving adequate medical attention. More than half of recent immigrants (those who have been in Canada for less than 10 years) who are eligible for screening did not utilize the program in the previous two years compared to 26 percent of Canadian-born women. Currently, prevention through screening is the primary form of breast cancer control in Canada, thus the differential access to screening among social, geographic, demographic and racial groups can severely affect one's chances of surviving. This paper provides an overview of inequitable outcomes across the breast cancer continuum due to racialization, with a particular focus on screening. It provides a brief description of racial and ethnic differences in screening utilization, diagnosis and survival drawing on local, national, and international data. It also provides a summary of important barriers to screening in racialized and ethnic minority women. It concludes with implications for Ontario and the Greater TorontoArea (GTA), and identifies possible directions forward.Racial, ethnic and socioeconomic differences in breast cancer screening have an important impact on the chance of both developing and dying from breast cancer. Therefore, we must acknowledge the negative impact of racialization and racism on health outcomes in Canada. In order to adequately address this problem, there is a need for community-based research that allows us to gain better insight into the perceptions, lived experiences and the multiple and often competing needs of women across racialized and immigrant communities in Ontario

Improving Awareness of Colon Cancer Screening in the Homeless Population of Burlington, Vermont

Homeless populations are significantly less likely to access preventative cancer screening, yet this is a major cause of morbidity and mortality in this population. In the general population, colorectal cancer affects 1 in 20 people and is the number 2 cancer killer. Rates of colorectal cancer screening are particularly low in homeless populations. A poster was developed and posted in the waiting room of Safe Harbor clinic, a homeless health care program center, in order to increase education and awareness about colon cancer screening and colonoscopy.https://scholarworks.uvm.edu/fmclerk/1449/thumbnail.jp

Temporal trends in mode, site and stage of presentation with the introduction of colorectal cancer screening: a decade of experience from the West of Scotland

background:  Population colorectal cancer screening programmes have been introduced to reduce cancer-specific mortality through the detection of early-stage disease. The present study aimed to examine the impact of screening introduction in the West of Scotland. methods:  Data on all patients with a diagnosis of colorectal cancer between January 2003 and December 2012 were extracted from a prospectively maintained regional audit database. Changes in mode, site and stage of presentation before, during and after screening introduction were examined. results:  In a population of 2.4 million, over a 10-year period, 14 487 incident cases of colorectal cancer were noted. Of these, 7827 (54%) were males and 7727 (53%) were socioeconomically deprived. In the postscreening era, 18% were diagnosed via the screening programme. There was a reduction in both emergency presentation (20% prescreening vs 13% postscreening, P0.001) and the proportion of rectal cancers (34% prescreening vs 31% pos-screening, P0.001) over the timeframe. Within non-metastatic disease, an increase in the proportion of stage I tumours at diagnosis was noted (17% prescreening vs 28% postscreening, P0.001). conclusions:  Within non-metastatic disease, a shift towards earlier stage at diagnosis has accompanied the introduction of a national screening programme. Such a change should lead to improved outcomes in patients with colorectal cancer