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Cancer Screening: Interventions Engaging Community Health Workers – Colorectal Cancer


What the CPSTF Found

About The Systematic Review

The CPSTF recommendation is based on evidence from a systematic review of 66 studies (search period through July 2017). Included studies evaluated intervention effects on breast (36 studies), cervical (29 studies), or colorectal (17 studies) cancer screening use—services recommended by the U.S. Preventive Services Task Force (2016a External Web Site Icon, 2018 External Web Site Icon, 2016b External Web Site Icon, respectively).

The systematic review was conducted on behalf of the CPSTF by a team of specialists in systematic review methods, and in research, practice, and policy related to cancer prevention and control.

Summary of Results

Detailed results from the systematic review are available in the CPSTF Finding and Rationale Statement.

The systematic review included 66 studies. Studies evaluated intervention effects on breast (36 studies), cervical (29 studies), or colorectal (17 studies) cancer screening use.

Colorectal Cancer Screening

  • Interventions that engaged community health workers, alone or as part of a team, increased colorectal cancer screening when compared with no intervention or usual care.
  • Increases in screening were observed for the following tests:
    • Up to date with any test: a median of 12.5 percentage points (9 studies),
    • Colonoscopy: a median of 13.0 percentage points (3 studies),
    • FOBT: a median of 8.0 percentage points (9 studies).

Breast, Cervical, or Colorectal Cancer Screening

The following results are based on an analysis of all included studies across breast, cervical, or colorectal cancer screening. Stratified analyses were performed for each cancer type and findings were comparable.

  • When compared to interventions that increase community demand or access alone, interventions that aimed to both increase community demand, and access to, screening services reported the largest increases in screening rates (median increase of 18.5 percentage points, 22 studies with 24 study arms).
  • Interventions engaged community health workers to implement between one and six intervention components.
    • While all of the studies reported increases in cancer screening, larger increases were seen when community health workers implemented more intervention components.
    • Interventions that provided group education produced larger increases in cancer screening (15.0 percentage points, 31 studies with 35 study arms) than those that provided one-on-one education (9.8 percentage points, 37 studies with 42 study arms).
    • Among studies that aimed to increase access to screening services, larger increases were reported when community health workers assisted with translation (30.2 percentage points, 4 studies with 4 study arms) or transportation barriers (26.8 percentage points, 9 studies with 9 study arms).
  • Lower baseline screening rates were associated with greater increases.

Summary of Economic Evidence

Evidence from the systematic economic review shows interventions engaging CHWs as part of a team increase colorectal cancer screening (by colonoscopy), are cost-effective, and may also result in net cost-savings. None of the included studies had CHWs delivering the interventions independently.

The systematic review of economic evidence included nine studies specific to colorectal cancer screening (search period through April 2019). Monetary values are reported in 2018 U.S. dollars.

  • The median cost per person targeted for screening was $1,150 for national interventions conducted in the United Kingdom and France (2 studies).
  • The median cost per person targeted for screening was $90 for CHW interventions in the United States (7 studies).
  • One study from the United States examined cost-benefit for three hospitals and reported mixed evidence. The median incremental cost per additional person screened was $5,752 in the U.K. and France studies and $117 for one U.S. study.
  • Evidence showing these interventions are cost-effective and may result in net cost savings came from two U.S. studies that reported a decline in incremental cost-effectiveness ratios below a conservative threshold of $50,000 per quality-adjusted life year saved.


Based on results from studies that assessed intervention effectiveness on breast, cervical, or colorectal cancer screening rates, findings should be applicable to a wide range of populations, across education and income levels, employment and insurance status, and race/ethnicity. Findings should be applicable to interventions set in healthcare systems or communities.

Evidence Gaps

The CPSTF identified several areas that have limited information. Additional research and evaluation could help answer the following questions and fill remaining gaps in the evidence base. (What are evidence gaps?)

  • What is the impact of these interventions on repeat screening?
  • Are these interventions effective among American Natives/Alaska Natives?
  • Is intervention effectiveness influenced by any of the following?
    • Participants’ health literacy
    • Supervision of community health workers
    • Compensation for community health workers
    • Inclusion of community health workers in research and evaluation
  • How does community health worker training affect outcomes? What is the best way to train them for this type of work?
  • Are the interventions using other types of screenings such as fecal immunochemical test (FIT) or FOBT cost-effective?
  • Are the interventions cost-effective in rural settings?
  • Do the monetary benefits exceed the intervention costs?

Study Characteristics

The following characteristics describe included studies across all three cancer types.

  • Studies were conducted in urban and rural areas of the United States (62 studies) and other high-income countries (8 studies).
  • Participants reported a mean age of 53 years and represented African American, Hispanic, Asian American, and white populations.