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Cancer > Cancer Screening > Reducing Structural Barriers
Client-oriented Cancer Screening Interventions:
Reducing Structural Barriers
On behalf of the Task Force on Community Preventive Services, a team of subject matter specialists and other scientists conducted a systematic review of published studies evaluating the effectiveness of reducing structural barriers to breast, cervical and colorectal cancer screenings.
The Task Force recommends interventions that reduce structural barriers based on evidence of their effectiveness in increasing:
- breast cancer screening by mammography, and
- colorectal cancer screening by fecal occult blood test (FOBT).
The Task Force concluded there was insufficient evidence to determine the effectiveness of reducing structural barriers to increase:
- cervical cancer screening by Pap test, and
- colorectal cancer screening by flexible sigmoidoscopy, colonoscopy, or double contrast barium enema.
- Interventions to reduce structural barriers are activities (other than economic) that make it easier for people to access preventive services in a clinical or non-clinical setting.
- Structural barriers may include location, distance, hours of operation, lack of daycare for dependents, navigation through the medical system, appointment scheduling, language, culture, work schedule, phone calls, and postage.
- Interventions to reduce structural barriers are based on the idea that making access to screening easier will increase demand for, and use of, screening. Examples include interventions that:
- reduce time or distance to delivery setting
- modify hours of service to meet client needs
- offer services in alternative, nonclinical setting (e.g., mobile vans)
- eliminate or simplify administrative procedures (e.g., scheduling help, transportation, translation), or
- provide secondary support, such as education or ways to reduce out-of-pocket costs.
Breast Cancer: Reducing Structural Barriers is Recommended to Increase Screening
Findings from the Systematic Review
- From seven studies that qualified for review, nine outcome measures demonstrated a median 17.7 percentage point increase in completed mammography.
- Reducing structural barriers to increase breast cancer screening by mammography should be most applicable to target populations who would otherwise accept screening and who have limited physical access to screening.
Cervical Cancer: More Evidence is Needed to Determine the Effectiveness of Reducing Structural Barriers to Increase Screening
Findings from the Systematic Review
- The two studies that qualified for the systematic review reported increases in Pap test completion of 17.8 and 13.6 percentage points.
- Because of too few studies the evidence was insufficient to determine the effectiveness of reducing structural barriers in increasing cervical cancer screening by Pap test.
Colorectal Cancer: Reducing Structural Barriers is Recommended to Increase Screening by FOBT (More evidence is needed to determine the effectiveness for other colorectal cancer screening methods)
Findings from the Systematic Review
- From seven studies that qualified for the systematic review, 12 outcome measures demonstrated a median 16.1 percentage point increase in completed FOBT.
- The findings of this review do not apply to screening by flexible sigmoidoscopy, colonoscopy, or double contrast barium enema, for which no studies were available.
- Reducing structural barriers to increase FOBT screening for colorectal cancer should be applicable in a variety of populations and settings where target populations who would otherwise accept screening may have limited physical access to these services.
Prior to and during the literature review and data analysis, the review team and the Task Force on Community Preventive Services attempt to address the key questions of what interventions work, for whom, under what conditions, and at what cost. Lack of sufficient information often leaves one or more of these questions unanswered. The Community Guide refers to these as “research gaps". Research gaps are pulled together in the form of a basic set of questions to inform a research agenda for those in the field. Each completed Community Guide review includes a section on research gaps (or issues) and this is included in final evidence review publications.
Cancer is a major public health problem in the United States. For more information on the scope of this problem, visit Background on Screening for Breast, Cervical and Colorectal Cancers.
Evidence Review:
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.
Am J Prev Med 2008;35(1S):56-66.
Recommendations:
Task Force on Community Preventive
Services. Recommendations for client- and
provider-directed interventions to increase
breast, cervical, and colorectal cancer screening
Am J Prev Med 2008;35(1S):21-5.
The findings and conclusions in this report are those of the authors and the Task Force on Community Preventive Services and do not necessarily represent the official position of the CDC.
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. Client-oriented cancer screening interventions: reducing structural barriers.
www.thecommunityguide.org/cancer/screening/reducing-structural-barriers.htm.
Last Updated: MM/DD/YYYY.
Review completed: July 2008
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