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CDC: Multicomponent Interventions Boost Colorectal, Breast, Cervical Cancer Screening
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Multicomponent interventions effectively increase colorectal cancer screening with colonoscopy or fecal occult blood testing, according to a CDC report.
The CDC’s Community Preventive Services Task Force also reported similar findings for increasing breast cancer and cervical cancer screening rates, and accordingly, they recommended implementing these measures to boost screening rates.
“Evidence suggests multicomponent interventions lead to greater effects when they combine strategies to increase community demand for, and access to, cancer screening,” the task force wrote. “The greatest effects come, however, when these two strategies are used together with the strategy to increase provider delivery of services.”
These recommendations are based on evidence from a systematic review of 88 studies published from 2004 through 2013, which evaluated interventions to increase colorectal cancer screening rates (56 studies) as well as breast cancer screening rates (33 studies) and cervical cancer screening rates (20 studies), using screening strategies recommended by the U.S. Preventive Services Task Force.
The CDC task force reviewed intervention components and grouped them into three categories: those that increase community demand for screening (client reminders and incentives, small or mass media, group or one-on-one education); those that increase community access to screening (reducing structural barriers and out-of-pocket costs); and those that increase delivery of screening services (assessment and feedback, incentives and reminders for providers).
Interventions aimed at reducing structural barriers included reducing administrative barriers, appointment scheduling assistance, alternative screening sites, additional screening hours, addressing transportation barriers, language translation services and child care.
They found that, compared with no intervention, multicomponent interventions led to a median increase of 15.4% in CRC screening using colonoscopy, FOBT or flexible sigmoidoscopy. Individually, they increased colonoscopy screening by a median of 10.2%, fecal occult blood testing (FOBT) by 7.7% and flexible sigmoidoscopy by 0.5%.
In a stratified analysis of different numbers and strategies of interventions (which also included studies of breast and cervical cancer screening rates), they found that multicomponent interventions that included all three of the abovementioned categories increased cancer screening rates by a median of 24.2%. Additionally, multicomponent interventions that used strategies to increase community demand and access increased cancer screening rates by a median of 11.2%.
“Multicomponent interventions that used two or more approaches increased cancer screening,” the task force wrote. “Interventions that used five or more approaches showed a larger increase than interventions with fewer approaches. Cancer screening increased independent of which approaches were used.”
Finally, they noted that interventions aimed at reducing structural barriers were effective for boosting screening rates: language translation services increased them by a median of 62.7% and addressing transportation increased them by 18.4%. None of the studies evaluated interventions that offered child care.
A combination of these interventions can be coordinated through health care systems and/or delivered in community settings to increase screening rates, especially in underserved populations, they concluded. Further, they called for additional research to address several evidence gaps, for example, the cost-effectiveness of these interventions and the effect of strategies for boosting repeat cancer screening. – by Adam Leitenberger
Reference:
Community Preventive Services Task Force Recommendations for Multicomponent Interventions to Increase Breast, Cervical, and Colorectal Cancer Screening. MMWR Morb Mortal Wkly Rep. 2017;doi:10.15585/mmwr.mm6628a7.
Disclosures: The task force members do not report any relevant financial disclosures.