Cancer Screening: Patient Navigation Services to Increase Cervical Cancer Screening and Advance Health Equity
The full CPSTF Finding and Rationale Statement and supporting documents for Cancer Screening: Patient Navigation Services to Increase Breast, Cervical, and Colorectal Cancer Screenings and Advance Health Equity are available in The Community Guide Collection on CDC Stacks.
The Community Preventive Services Task Force (CPSTF) recommends patient navigation services to increase cervical cancer screening by Pap test among historically disadvantaged racial and ethnic populations and people with lower incomes.
Patient navigation services are expected to advance health equity when implemented among these populations who often have lower screening rates (Sabatino et al. 2021). With timely and appropriate follow-up care and treatment, patient navigation services may improve health for these groups.
The CPSTF has related findings for patient navigation interventions to increase screenings for the following:
- Breast cancer (recommended)
- Colorectal cancer (recommended)
The CPSTF finding is based on evidence from a systematic review that examined intervention effectiveness in increasing breast, cervical, or colorectal cancer screenings. The review included 34 studies identified from an existing systematic review (Nelson et al. 2020; search period January 1996 to July 2019) and an updated search (search period through November 2021).
Of the 34 included studies, 3 evaluated intervention effects on cervical cancer screening.
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.
The following characteristics describe the 34 included studies across all three cancer types.
- All included studies were conducted in the United States.
- Studies were conducted in clinic (22 studies) or clinic and community (12 studies) settings, and in urban (26 studies), rural (5 studies), or a mix of urban and rural areas (2 studies).
- Study participants had a mean age of 59.5 years (25 studies), self-identified as American Indian or Alaska Native (1 study), Asian (4 studies), Black or African American (15 studies), Hispanic or Latino (11 studies), Native Hawaiian (1 study), or White (14 studies).
- Among studies that reported on income and education, the majority of study participants had annual incomes below 150% of the federal poverty level (16 studies), and had a high school education or less (14 studies).
- Interventions offered one to six services including assistance with appointment scheduling (20 studies) or transportation (13 studies), reductions in administrative barriers (23 studies), and one-on-one education (24 studies).
- Services were delivered remotely (15 studies) or both remotely and face-to-face (18 studies); no services were delivered face-to-face only.
- Services were most often delivered by CHWs or dedicated patient navigators who worked alone (CHWs, 6 studies; navigator, 14 studies) or on a team (CHWs, 3 studies; navigator, 6 studies).
The systematic review included three studies.
- Patient navigation interventions increased cervical cancer screening by a median of 22.5 percentage points or 64.5%.
The systematic review of economic evidence did not identify enough studies to determine the cost-effectiveness of patient navigation services to increase cervical cancer screening.
- Cost per quality-adjusted life year (QALY): $924 (1 study).
The economic review (search period through December 2022) included two studies for cervical cancer and two studies for multiple cancers (breast, cervical, and other cancers). All studies were conducted in the United States, and monetary values are reported in 2022 dollars.
- Intervention costs per person for cervical cancer screening intervention: $103 and $794 (2 studies).
- Costs per additional person screened: $533 and $56
Based on results from the systematic review, findings are applicable to adults and older adults with different baseline screening status, across educational levels, employment, and insurance status.
Evidence suggests programs can be offered in urban or rural settings, include different intervention components, and be delivered by a range of providers who work alone or as part of a team.
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?)
- How effective are patient navigation services in increasing the following?
- What is the cost-effectiveness of patient navigation services to increase cervical cancer screening?
Remaining questions for research and evaluation identified by CPSTF:
- How effective are patient navigation services in increasing the following?
- Cervical cancer screening that includes HPV tests
- Does intervention effectiveness vary by the following?
- Participants’ health literacy
- Number of interactions between service deliverers and participants
- What is the precise economic impact of patient navigation services within comprehensive health promotion interventions?
Evidence from the systematic review suggests patient navigation services adjusted to fit local needs and resources can increase cancer screenings among people from historically disadvantaged racial or ethnic groups and people with lower incomes. Evidence suggests programs with different intervention characteristics implemented in different settings will be effective.
- Patient navigation services examined in this review were delivered by a wide array of deliverers, including CHWs, trained lay patient or professional navigators, nurses, case managers, or clinic staff. Delivery may be enhanced when deliverers have local knowledge, provide language-appropriate and culturally competent services, have flexible working hours to better fit patients’ schedules, and work closely with healthcare providers.
- Patient navigation services can be delivered remotely, which might help in rural areas or other settings where transportation is difficult. Programs may combine face-to-face and remote interactions based on the unique needs of the delivers and patients.
- Patient navigation services can be provided at every step along the cancer continuum to guide patients through the healthcare system and reduce cancer mortality, and in some cases incidence.
Evidence-Based Cancer Control Programs (EBCCP) Crosswalks
Find programs from the EBCCP website that align with this systematic review.
Healthy People 2030 Crosswalks
Healthy People 2030 includes the following objectives related to this CPSTF recommendation.