Cancer Screening: One-on-One Education for Clients — Breast Cancer

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Findings and Recommendations

The Community Preventive Services Task Force (CPSTF) recommends the use of one-on-one education to increase screening for breast cancers on the basis of strong evidence of effectiveness.

The full CPSTF Finding and Rationale Statement and supporting documents for Cancer Screening: One-on-One Education for Clients — Breast Cancer are available in The Community Guide Collection on CDC Stacks.

Intervention

One-on-one education delivers information to individuals about indications for, benefits of, and ways to overcome barriers to cancer screening with the goal of informing, encouraging, and motivating them to seek recommended screening. These messages are delivered by healthcare workers or other health professionals, lay health advisors, or volunteers, and are conducted by telephone or in person in medical, community, worksite, or household settings.

These messages can be untailored to address the overall target population or tailored with the intent to reach one specific person, based on characteristics unique to that person, related to the outcome of interest, and derived from an individual assessment. One-on-one education is often accompanied by supporting materials delivered via small media (e.g., brochures) and may also involve client reminders.

About The Systematic Review

The CPSTF finding is based on evidence from a Community Guide systematic review published in 2008 (Baron et al., 25 studies, search period 1966-2004) combined with more recent evidence (9 studies, search period 2004-2008). 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.

Study Characteristics

Following are characteristics of included studies from the updated search period.

  • Interventions were delivered in the home (9 studies) or clinic (1 study), by medical (2 studies) and nonmedical professionals (7 studies), by telephone (7 studies), or in person (3 studies).
  • Most studies included tailored components.
  • Studies were conducted in the U.S. and included urban and rural populations.
  • Studies included participants who were African-American, Hispanic, Asian-American, and Native American; had low SES; and had increased risk for breast cancer.
  • Outcomes were assessed by self-report or medical record review.

Summary of Results

The 2008 review included 19 studies. This update included an additional 6 studies. Combined evidence from both the original and the updated review showed the following.

  • Mammography screening: median increase of 11.9 percentage points (range 6.5 to 15.2; 7 study arms)
  • Results from two additional study arms with women at higher risk of breast cancer showed 1 to 18 percentage point increases in mammography use.
  • Tailored interventions showed a median increase of 9.7 percentage points (IQI: 6.5 to 15.2 percentage points; 30 study arms).
  • Untailored interventions showed a median increase of 6.3 percentage points (IQI: 2.0 to 11.4 percentage points; 9 study arms).
  • One-on-one education programs targeted to lower income women showed greater effects (10.4 percentage points, IQI: 9.4 to 15.1 percentage points; 13 study arms) when compared with programs that did not target lower income women (8.8 percentage points, IQI 2.0 to 14.4 percentage points; 26 study arms).
  • The incremental effect of one-on-one education when added to other types of interventions was a median increase of 6.1 percentage points (IQI: 2.0 to 11.0; 15 study arms)

Summary of Economic Evidence

The updated search for evidence included nine studies about breast cancer (5 studies), cervical cancer (1 study), or colorectal cancer (3 studies) screening. Monetary values are presented in 2009 U.S dollars.

  • Of the nine included studies, eight reported results from actual interventions and one used economic modeling. The cost per additional screening ranged from $39 to $5,306, with a median of $534. The most expensive intervention was the most resource intensive. Lay health advisors conducted three in-person home visits, made follow-up phone calls, and sent mailings that addressed barriers to screening.

Implementation Considerations and Resources

  • Recruitment and training of educators, quality-control measures, duration of educational sessions, travel for in-person education, and professional backgrounds of educators may influence costs and feasibility of implementation.
  • Interventions may require special skills or tools to develop messages, including tailored messages

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