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Cancer Screening: Reducing Structural Barriers for Clients – Colorectal Cancer

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What the CPSTF Found

About The Systematic Review

The CPSTF finding for reducing structural barriers to increase screening for colorectal cancer by FOBT is based on evidence from a Community Guide systematic review published in 2008 (Baron et al., 7 studies, search period 1966-2004) combined with more recent evidence (5 studies, search period 2004-2008).

The CPSTF finding for reducing structural barriers 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 (5 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 finding on Cancer Screening: Reducing Structural Barriers – Colorectal Cancer by Fecal Occult Blood Testing pdf icon [PDF - 254 kB] and Cancer Screening: Reducing Structural Barriers – Colorectal Cancer by Colonoscopy or Flexible Sigmoidoscopy pdf icon [PDF - 248 kB].

Summary of Results

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

Results of the Previous Review

The original reviews included 7 studies on reducing structural barriers to increase cancer screening by FOBT.

  • Screening by fecal occult blood test (FOBT): median increase of 16.1 percentage points (IQI: 12.1 to 22.9 percentage points; 11 study arms)
Results of the Updated Review

Of the five additional studies that qualified for the review, 2 reported on screening by FOBT, 1 reported on the mean number of colonoscopies per month, 1 looked at screening by colonoscopy or FOBT, and 1 reported on any of three testing modalities (FOBT, colonoscopy, or sigmoidoscopy).

  • Colorectal cancer screening by any test: median increase of 36.9 percentage points (range: 16.3 to 41.1 percentage points; 4 study arms)
  • One study reported a 9.5% relative increase in the mean number of colonoscopies per month.

Summary of Economic Evidence

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

Three studies qualified for the review of evidence for colorectal cancer screening by FOBT. Monetary values are presented in 2009 U.S dollars.

  • Two studies measured the cost per additional screen by FOBT to be $63.20 and $424.67.
  • One study estimated a cost-effectiveness ratio of $3000 to $4000 per year of life saved.

Applicability

  • The original review findings were applicable across a range of settings where target populations may have limited physical access to FOBT.
  • Evidence from the updated search period about reducing structural barriers to increase screening by FOBT expands applicability to include diverse populations as the additional studies included some from another high-income economy and some samples included other populations (e.g., Native Hawaiians, Hispanics).

Evidence Gaps

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

  • 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?

Study Characteristics

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

  • Most evidence focused on approaches to reduce time and distance to completing screening (e.g., mailing FOBT cards to clients).
  • Studies were conducted in the U.S. and France and in medical care and community settings.
  • All studies enrolled men and women aged ≥50 years.
  • Specified racial/ethnic groups included whites, Hispanics/Latinos, African Americans, and Native Hawaiians.
  • Included populations also varied, from residents of urban communities to residents of a remote Hawaiian Island.
  • Outcomes were assessed by proportion of returned kits, self-report, and medical record review.

Publications