title: Unifying screening processes within the PROSPR consortium: a conceptual model for breast, cervical, and colorectal cancer screening.
abstract: General frameworks of the cancer screening process are available, but none directly compare the process in detail across different organ sites. This limits the ability of medical and public health professionals to develop and evaluate coordinated screening programs that apply resources and population management strategies available for one cancer site to other sites. We present a trans-organ conceptual model that incorporates a single screening episode for breast, cervical, and colorectal cancers into a unified framework based on clinical guidelines and protocols; the model concepts could be expanded to other organ sites. The model covers four types of care in the screening process: risk assessment, detection, diagnosis, and treatment. Interfaces between different provider teams (eg, primary care and specialty care), including communication and transfer of responsibility, may occur when transitioning between types of care. Our model highlights across each organ site similarities and differences in steps, interfaces, and transitions in the screening process and documents the conclusion of a screening episode. This model was developed within the National Cancer Institute-funded consortium Population-based Research Optimizing Screening through Personalized Regimens (PROSPR). PROSPR aims to optimize the screening process for breast, cervical, and colorectal cancer and includes seven research centers and a statistical coordinating center. Given current health care reform initiatives in the United States, this conceptual model can facilitate the development of comprehensive quality metrics for cancer screening and promote trans-organ comparative cancer screening research. PROSPR findings will support the design of interventions that improve screening outcomes across multiple cancer sites.
authors.affiliation: : Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA (EFB); Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA (JJK); Division of General Internal Medicine, University of Pennsylvania, Philadelphia, PA (MMS); Department of Veterans Affairs Medical Center, Philadelphia, PA (MMS); Department of Medicine and The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon, NH (ANAT); Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY (AGZ); Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD (AMG); Group Health Research Institute, Seattle, WA (AK); Department of Pathology and University of Vermont Cancer Center, University of Vermont, Burlington, VT (DLW); Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX (JAT). ebeaber@fredhutch.org.
authors.forename: Elisabeth F
authors.initials: EF
authors.lastname: Beaber
authors.affiliation: : Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA (EFB); Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA (JJK); Division of General Internal Medicine, University of Pennsylvania, Philadelphia, PA (MMS); Department of Veterans Affairs Medical Center, Philadelphia, PA (MMS); Department of Medicine and The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon, NH (ANAT); Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY (AGZ); Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD (AMG); Group Health Research Institute, Seattle, WA (AK); Department of Pathology and University of Vermont Cancer Center, University of Vermont, Burlington, VT (DLW); Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX (JAT).
authors.forename: Jane J
authors.initials: JJ
authors.lastname: Kim
authors.affiliation: : Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA (EFB); Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA (JJK); Division of General Internal Medicine, University of Pennsylvania, Philadelphia, PA (MMS); Department of Veterans Affairs Medical Center, Philadelphia, PA (MMS); Department of Medicine and The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon, NH (ANAT); Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY (AGZ); Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD (AMG); Group Health Research Institute, Seattle, WA (AK); Department of Pathology and University of Vermont Cancer Center, University of Vermont, Burlington, VT (DLW); Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX (JAT).
authors.forename: Marilyn M
authors.initials: MM
authors.lastname: Schapira
authors.affiliation: : Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA (EFB); Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA (JJK); Division of General Internal Medicine, University of Pennsylvania, Philadelphia, PA (MMS); Department of Veterans Affairs Medical Center, Philadelphia, PA (MMS); Department of Medicine and The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon, NH (ANAT); Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY (AGZ); Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD (AMG); Group Health Research Institute, Seattle, WA (AK); Department of Pathology and University of Vermont Cancer Center, University of Vermont, Burlington, VT (DLW); Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX (JAT).
authors.forename: Anna N A
authors.initials: AN
authors.lastname: Tosteson
authors.affiliation: : Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA (EFB); Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA (JJK); Division of General Internal Medicine, University of Pennsylvania, Philadelphia, PA (MMS); Department of Veterans Affairs Medical Center, Philadelphia, PA (MMS); Department of Medicine and The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon, NH (ANAT); Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY (AGZ); Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD (AMG); Group Health Research Institute, Seattle, WA (AK); Department of Pathology and University of Vermont Cancer Center, University of Vermont, Burlington, VT (DLW); Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX (JAT).
authors.forename: Ann G
authors.initials: AG
authors.lastname: Zauber
authors.affiliation: : Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA (EFB); Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA (JJK); Division of General Internal Medicine, University of Pennsylvania, Philadelphia, PA (MMS); Department of Veterans Affairs Medical Center, Philadelphia, PA (MMS); Department of Medicine and The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon, NH (ANAT); Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY (AGZ); Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD (AMG); Group Health Research Institute, Seattle, WA (AK); Department of Pathology and University of Vermont Cancer Center, University of Vermont, Burlington, VT (DLW); Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX (JAT).
authors.forename: Ann M
authors.initials: AM
authors.lastname: Geiger
authors.affiliation: : Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA (EFB); Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA (JJK); Division of General Internal Medicine, University of Pennsylvania, Philadelphia, PA (MMS); Department of Veterans Affairs Medical Center, Philadelphia, PA (MMS); Department of Medicine and The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon, NH (ANAT); Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY (AGZ); Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD (AMG); Group Health Research Institute, Seattle, WA (AK); Department of Pathology and University of Vermont Cancer Center, University of Vermont, Burlington, VT (DLW); Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX (JAT).
authors.forename: Aruna
authors.initials: A
authors.lastname: Kamineni
authors.affiliation: : Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA (EFB); Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA (JJK); Division of General Internal Medicine, University of Pennsylvania, Philadelphia, PA (MMS); Department of Veterans Affairs Medical Center, Philadelphia, PA (MMS); Department of Medicine and The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon, NH (ANAT); Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY (AGZ); Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD (AMG); Group Health Research Institute, Seattle, WA (AK); Department of Pathology and University of Vermont Cancer Center, University of Vermont, Burlington, VT (DLW); Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX (JAT).
authors.forename: Donald L
authors.initials: DL
authors.lastname: Weaver
authors.affiliation: : Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA (EFB); Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA (JJK); Division of General Internal Medicine, University of Pennsylvania, Philadelphia, PA (MMS); Department of Veterans Affairs Medical Center, Philadelphia, PA (MMS); Department of Medicine and The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon, NH (ANAT); Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY (AGZ); Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD (AMG); Group Health Research Institute, Seattle, WA (AK); Department of Pathology and University of Vermont Cancer Center, University of Vermont, Burlington, VT (DLW); Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX (JAT).
authors.forename: Jasmin A
authors.initials: JA
authors.lastname: Tiro
mesh_terms: D001943:Breast Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000379:methods*; D015233:Models, Statistical; D054547:National Cancer Institute (U.S.); D012109:Research Support as Topic; D018570:Risk Assessment; D014481:United States / Q000453:epidemiology; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy