Effectiveness of Multicomponent Interventions in Increasing Breast, Cervical and Colorectal Cancer Screening Use: A Community Guide Systematic Review

Authors:

Susan Sabatino (Presenter)
CDC

Yinan Peng, CDC
Devon Okasako-Schmucker, CDC
Ismaila Ramon, CDC
Randy Elder, CDC
Sushama Dhakal-Acharya, CDC Foundation
Adesola Pitan, University of Georgia
Shawna Mercer, CDC

Public Health Statement: Many adults are not up-to-date with cancer screening.

Purpose: To determine effectiveness of multicomponent interventions (MCIs) in increasing breast, cervical and colorectal cancer (CRC) screening use.

Methods/Approach: Following Community Guide methods, we conducted a systematic review of studies that were primary investigations in countries with high-income economies. Eligible screening outcomes included completed recent or repeat mammography, Pap test, and/or CRC screening. MCIs include two or more approaches to increase community demand, increase screening access or increase provider delivery of screening, or to reduce different structural barriers. Summary effect measures were calculated. Eighty-eight studies were included.

Results: Compared to no intervention, MCIs increased screening use for all three cancers, (CRC: median absolute increase 15.4 percentage points (pp), interquartile interval (IQI) 6.0–21.6, 39 study arms; mammography: median 6.2 pp, IQI 0.9–14.5, 34 arms; Pap: median 6.1 pp, IQI 1.1–11.6, 19 arms). For specific CRC tests, increases were observed for colonoscopy (median 10.2 pp, IQI 5.0–12.5, 9 arms) and fecal occult blood test (FOBT) (median 7.7 pp, IQI 2.3–21.1, 21 arms). The largest increases occurred for MCIs that combined strategies to increase community demand, screening access and provider screening delivery (median 24.2 pp, IQI 8.8–39.0, 5 arms), or that combined increasing demand and access (median 11.2 pp, IQI 5.3–18.2, 48 arms).

Conclusions/Implications: MCIs are effective in increasing breast, cervical and CRC screening. For CRC screening, MCIs increased use of colonoscopy and FOBT. Findings suggest that including approaches to increase community demand and access is important, and that addressing demand, access, and provider delivery may be most effective.