Increasing Cancer Screening: Reducing Structural Barriers for Clients

(2008 Archived Review)

Many barriers can make it difficult for people to seek screening for cancer. They include distance from screening location, limited hours of operation, lack of daycare for children, and language and cultural factors. These types of interventions seek to increase screening by removing structural barriers.

Summary of Task Force Recommendations & Findings

The Community Preventive Services Task Force recommends interventions that reduce structural barriers based on strong evidence of their effectiveness in increasing:

• Breast cancer screening by mammography
• Colorectal cancer screening by fecal occult blood test (FOBT)

The Community Preventive Services Task Force finds insufficient evidence to determine the effectiveness of reducing structural barriers to increase:

• Cervical cancer screening by Pap test (based on a small number of studies with methodological limitations)
• Colorectal cancer screening by flexible sigmoidoscopy, colonoscopy, or double contrast barium enema (no studies qualified for review)

Task Force finding

Results from the Systematic Review

Breast Cancer

Seven studies qualified for the systematic review.

• Proportion of study participants completing mammography: median increase of 17.7 percentage points (7 studies)

Findings should be applicable to a range of settings where women have limited physical access to mammography.

Find a Research-tested Intervention Program (RTIP) about reducing structural barriers to increase breast cancer screening (What is an RTIP?).

Cervical Cancer

The evidence was insufficient to determine effectiveness because too few studies (only two studies) of adequate quality were found. The two studies reported increases in Pap test completion of 17.8 and 13.6 percentage points.

Colorectal Cancer

Seven studies of colorectal cancer screening by FOBT qualified for the systematic review.

• Proportion of study participants completing FOBT: median increase of 16.1 percentage points (7 studies)
• Three studies were found that assessed costs per increased screening by FOBT.
  • Costs per additional screening varied widely across studies, from $0.64 for supplying a return FOBT kit envelope with prepaid postage versus usual in-person return to $32.10 for mailing a return postage prepaid FOBT kit with a follow-up telephone reminder during a mass media campaign versus exposure to the mass media campaign alone which offered FOBT kit at no cost to client.

Findings should be applicable among many groups who would accept screening but have limited physical access to these services.

No studies of screening by flexible sigmoidoscopy, colonoscopy, or double contrast barium enema qualified for the review.

These findings were based on a systematic review of all available studies, conducted on behalf of the Task Force by a team of specialists in systematic review methods, and in research, practice and policy related to cancer prevention and control.

Supporting Materials

• Analytic framework [PDF - 410KB]
• Summary evidence table [PDF - 35KB]
• Included Studies [PDF - 22KB]
• Search Strategy

Publications

Baron RC, Rimer BK, Coates RJ, et al. Client-directed interventions to increase community access to breast, cervical, and colorectal cancer screening: a systematic review. [PDF - 458KB] Am J Prev Med 2008;35(1S):56-66.

Task Force on Community Preventive Services. Recommendations for client- and provider-directed interventions to increase breast, cervical, and colorectal cancer screening. [PDF - 74KB] Am J Prev Med 2008;35(1S): S21-5.

More Community Guide publications about Cancer Prevention and Control

---



Sample Citation

The content of publications of the Guide to Community Preventive Services is in the public domain. Citation as to source, however, is appreciated. Sample citation:
Guide to Community Preventive Services. Increasing cancer screening: reducing structural barriers for clients (2008 archived review). www.thecommunityguide.org/cancer/screening/client-oriented/ReducingStructuralBarriers_archive.html. Last updated: MM/DD/YYYY.

Review completed: July 2008