Cancer Screening: Reducing Structural Barriers for Clients — Cervical Cancer

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Findings and Recommendations

The Community Preventive Services Task Force (CPSTF) finds insufficient evidence to determine whether reducing structural barriers is effective in increasing cervical cancer screening because only three relevant studies were identified, and these had some methodological limitations.

The full CPSTF Finding and Rationale Statement and supporting documents for Cancer Screening: Reducing Structural Barriers for Clients — Cervical Cancer are available in The Community Guide Collection on CDC Stacks.

Intervention

Structural barriers are non-economic burdens or obstacles that make it difficult for people to access cancer screening. Interventions designed to reduce these barriers may facilitate access to cancer screening services by:

  • Reducing time or distance between service delivery settings and target populations
  • Modifying hours of service to meet client needs
  • Offering services in alternative or non-clinical settings (e.g., mobile mammography vans at worksites or in residential communities)
  • Eliminating or simplifying administrative procedures and other obstacles (e.g., scheduling assistance, patient navigators, transportation, dependent care, translation services, limiting the number of clinic visits)

Such interventions often include one or more secondary supporting measures, such as printed or telephone reminders, education about cancer screening, information about screening availability, or measures to reduce out-of-pocket costs to the client.

About The Systematic Review

The CPSTF finding 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 (1 study, search period 2004-2008).

Study Characteristics

  • One study examined a nurse-led clinic within a correctional facility, one offered onsite screening to residents at a high-rise apartment building, and one invited participants to receive screening during extended hours.
  • Studies were conducted in the U.S., Canada, and Australia.

Summary of Results

Three studies qualified for the review.

  • Pap screening: median increase of 13.6 percentage points (range: 5.9 to 17.8)
  • While these results were in the favorable direction, the studies had some methodological limitations

Summary of Economic Evidence

An economic review of this intervention was not conducted because CPSTF did not have enough information to determine if the intervention works.

Applicability

Applicability of this intervention across different settings and populations was not assessed because CPSTF did not have enough information to determine if the intervention works.

Evidence Gaps

The following outlines evidence gaps for interventions to reduce structural barriers to increase breast, cervical, or colorectal cancer screening.

  • Are interventions effective for promoting colorectal cancer screening with methods other than FOBT?
  • Are interventions to promote colorectal cancer screening equally effective when addressing colorectal cancer screening more generally, as when specific to one type of test?
  • 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?

Implementation Considerations and Resources

CPSTF did not have enough evidence to determine whether the intervention is or is not effective. This does not mean that the intervention does not work, but rather that additional research is needed to determine whether or not the intervention is effective.

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