Effectiveness of interventions to increase screening for breast, cervical, and colorectal cancers: nine updated systematic reviews for the guide to community preventive services.
BACKGROUND
Screening reduces mortality from breast, cervical, and colorectal cancers. The Guide to Community Preventive Services previously conducted systematic reviews on the effectiveness of 11 interventions to increase screening for these cancers. This article presents results of updated systematic reviews for nine of these interventions.


METHODS
Five databases were searched for studies published during January 2004-October 2008. Studies had to (1) be a primary investigation of one or more intervention category; (2) be conducted in a country with a high-income economy; (3) provide information on at least one cancer screening outcome of interest; and (4) include screening use prior to intervention implementation or a concurrent group unexposed to the intervention category of interest. Forty-five studies were included in the reviews.


RESULTS
Recommendations were added for one-on-one education to increase screening with fecal occult blood testing (FOBT) and group education to increase mammography screening. Strength of evidence for client reminder interventions to increase FOBT screening was upgraded from sufficient to strong. Previous findings and recommendations for reducing out-of-pocket costs (breast cancer screening); provider assessment and feedback (breast, cervical, and FOBT screening); one-on-one education and client reminders (breast and cervical cancer screening); and reducing structural barriers (breast cancer and FOBT screening) were reaffirmed or unchanged. Evidence remains insufficient to determine effectiveness for the remaining screening tests and intervention categories.


CONCLUSIONS
Findings indicate new and reaffirmed interventions effective in promoting recommended cancer screening, including colorectal cancer screening. Findings can be used in community and healthcare settings to promote recommended care. Important research gaps also are described.
Division of Cancer Prevention and Control, CDC, Atlanta, Georgia 30341, USA. SSabatino@cdc.gov
Susan A
SA
Sabatino
Briana
B
Lawrence
Randy
R
Elder
Shawna L
SL
Mercer
Katherine M
KM
Wilson
Barbara
B
DeVinney
Stephanie
S
Melillo
Michelle
M
Carvalho
Stephen
S
Taplin
Roshan
R
Bastani
Barbara K
BK
Rimer
Sally W
SW
Vernon
Cathy Lee
CL
Melvin
Vicky
V
Taylor
Maria
M
Fernandez
Karen
K
Glanz
D000293:Adolescent; D000328:Adult; D001943:Breast Neoplasms / Q000175:diagnosis*; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D005260:Female; D005382:Financing, Personal; D006293:Health Promotion / Q000379:methods* / Q000592:standards; D006801:Humans; D008403:Mass Screening / Q000706:statistics & numerical data*; D011314:Preventive Health Services; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*; D055815:Young Adult