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Cancer Screening: One-on-One Education for Clients – Colorectal Cancer

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What the CPSTF Found

About The Systematic Review

The CPSTF finding for one-on-one education to increase screening for colorectal cancer by FOBT is based on evidence from a Community Guide systematic review published in 2008 (Baron et al., 2 studies, search period 1966-2004) combined with more recent evidence (3 studies, search period 2004-2008). The CPSTF finding for one-on-one education to increase screening for colorectal cancer by colonoscopy or flexible sigmoidoscopy is based on evidence from a Community Guide systematic review published in 2008 (Baron et al., 0 studies, search period 1966-2004) combined with more recent evidence (4 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. This finding updates and replaces the 2008 CPSTF findings on Cancer Screening: One-On-One Education - Colorectal Cancer with Fecal Occult Blood Testing (FOBT) pdf icon [PDF - 331 kB] and Cancer Screening: One-On-One Education - Colorectal Cancer by Colonoscopy or Flexible Sigmoidoscopy pdf icon [PDF - 331 kB].

Summary of Results

Detailed results from the systematic review are available in the published evidence review pdf icon [PDF - 229 kB].

Combined evidence from the original and updated reviews included 5 studies on one-on-one education to increase cancer screening by FOBT.

  • Screening by fecal occult blood test (FOBT): median increase of 19.1 percentage points (interquartile interval [IQI]: 12.9 to 25.1 percentage points; 10 study arms).
  • Tailored interventions showed increase ranging from 1 to 20.7 percentage points (2 studies)
  • Untailored interventions showed a median increase of 20.7 percentage points (IQI: 13.8 to 25.8 percentage points; 3 studies with 8 study arms)

Combined evidence from the original and updated reviews included 4 studies on one-on-one education to increase cancer screening by colonoscopy or flexible sigmoidoscopy.

  • Screening by colonoscopy: range from 0 to 11 percentage points increase (2 study arms)
  • Screening by flexible sigmoidoscopy: no change reported (1 study arm)
  • Screening by any test (including FOBT): range from 1 to 11 percentage point increase (2 study arms)

Summary of Economic Evidence

Detailed results from the systematic review are available in the published evidence review pdf icon [PDF - 229 kB].

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.

Applicability

Results from this review should apply across a range of populations, provided intervention programs to increase colorectal cancer screening by FOBT are adapted to target population and delivery context. Although no studies specifically noted inclusion of rural populations, findings are not expected to differ from those of urban and unspecified populations.

Evidence Gaps

Additional research and evaluation are needed to answer the following questions and fill existing gaps in the evidence base. (What are evidence gaps?)

  • What duration, dose, and intensity of one-on-one educational interventions are needed to be effective?
  • What characteristics of "tailoring" contribute to its effect? Are there effects of tailoring channels (personal interaction, anonymous interaction)?
  • Does effectiveness of one-on-one education interventions vary according to whether or not education is delivered by a medical professional?
  • What are the incremental effects of adding intervention components to other interventions?
  • What influence do newer methods of communication (e.g., the Internet, e-mail, social media, automated interactive voice response, texting) have on intervention effectiveness?
  • What is the influence of health system factors on intervention effectiveness?
  • Are interventions effective for promoting colorectal cancer screening with methods other than FOBT?
  • Are interventions to promote colorectal cancer screening equally effective when specific to one type of test as they are when addressing colorectal cancer screening more generally?

Study Characteristics

  • Interventions were delivered in home and clinic settings, by phone, in person, or by medical professionals or others.
  • In addition to white participants, studies included African-American, Hispanic, and Asian-American participants; participants with low socioeconomic status; and urban populations.
  • All studies were conducted in the U.S., and none specified inclusion of rural populations.
  • Most studies included participants 50 years and older.

Publications