- Cancer is the second leading cause of death in the United States, killing more than 553,000 Americans each year (CDC)
. - In 2006, the cost of medical care for cancer was an estimated $104.1 billion in the United States (National Cancer Institute) .
- More systematic efforts to expand use of established screening tests, reduce tobacco use and obesity, and improve diet and physical activity could prevent much of the suffering and death from cancer (ACS) .
- From 2004 – 2006, approximately half of colorectal and cervical cancer cases and one third of breast cancer cases were diagnosed at a late stage of disease; this could be partially explained by screening use differences (CDC) .
Community Guide Recommendations
Client-oriented interventions to increase breast, cervical, & colorectal cancer screening
Interventions for clients either provide education to increase cancer screening or make it easier for clients to be screened. Results are reported separately for breast, cervical, and colorectal cancer screening because routine screening recommendations differ by age and sex.
Client reminders
Recommended for: Breast cancer, cervical cancer, and colorectal cancer.
Client reminders are written (letter, postcard, email) or telephone messages (including automated messages) advising people that they are due for screening. Client reminders may be enhanced by one or more of the following:
- Follow-up printed or telephone reminders
- Additional text or discussion with information about indications for, benefits of, and ways to overcome barriers to screening
- Assistance in scheduling appointments
These interventions can be untailored to address the overall target population or tailored with the intent to reach one specific person, based on characteristics unique to that person, related to the outcome of interest, and derived from an individual assessment.
Small media
Recommended for: Breast cancer, cervical cancer, and colorectal cancer.
Small media include videos and printed materials such as letters, brochures, and newsletters. These materials can be used to inform and motivate people to be screened for cancer. They can provide information tailored to specific individuals or targeted to general audiences.
Group education
Recommended for: Breast cancer.
Group education conveys information on indications for, benefits of, and ways to overcome barriers to screening with the goal of informing, encouraging, and motivating participants to seek recommended screening. Group education is usually conducted by health professionals or by trained laypeople who use presentations or other teaching aids in a lecture or interactive format, and often incorporate role modeling or other methods. Group education can be given to a variety of groups, in different settings, and by different types of educators with different backgrounds and styles.
One-on-one education
Recommended for: Breast cancer, cervical cancer, and colorectal cancer.
One-on-one education delivers information to individuals about indications for, benefits of, and ways to overcome barriers to cancer screening with the goal of informing, encouraging, and motivating them to seek recommended screening. These messages are delivered by healthcare workers or other health professionals, lay health advisors, or volunteers, and are conducted by telephone or in person in medical, community, worksite, or household settings.
These interventions can be untailored to address the overall target population or tailored with the intent to reach one specific person, based on characteristics unique to that person, related to the outcome of interest, and derived from an individual assessment. One-on-one education is often accompanied by supporting materials delivered via small media (e.g., brochures), and may also involve client reminders.
Reducing structural barriers
Recommended for:
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 or 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 (e.g., group education, pamphlets, or brochures)
- Measures to reduce out-of-pocket costs to the client (though interventions principally designed to reduce client costs are considered to be a separate class of approaches)
Reducing client out-of-pocket costs
Recommended for: Breast cancer.
Interventions to reduce client out-of-pocket costs attempt to minimize or remove economic barriers that make it difficult for clients to access cancer screening services. Costs can be reduced through a variety of approaches, including vouchers, reimbursements, reduction in co-pays, or adjustments in federal or state insurance coverage. Efforts to reduce client costs may be combined with measures to provide client education, information about program availability, or measures to reduce structural barriers.
Provider-oriented interventions to increase breast, cervical, & colorectal cancer screening
Physicians and other providers can play an important role in encouraging patients to be screened for cancer. Provider-oriented interventions aim to increase recommendation and delivery of screening for breast, cervical and colorectal cancers by healthcare providers.
Provider assessment and feedback
Provider assessment and feedback interventions both evaluate provider performance in delivering or offering screening to clients (assessment) and present providers with information about their performance in providing screening services (feedback). Feedback may describe the performance of a group of providers (e.g., mean performance for a practice) or an individual provider, and may be compared with a goal or standard.
Provider reminder and recall systems
Reminders inform health care providers it is time for a client’s cancer screening test (called a “reminder”) or that the client is overdue for screening (called a “recall”). The reminders can be provided in different ways, such as in client charts or by e-mail.
Education and policy interventions to prevent skin cancer
These interventions combine education and policy approaches to increase preventive behaviors (e.g., covering up, using shade, avoiding sun during peak UV hours) among populations in specific settings.
Primary school settings
Interventions in primary school settings are designed to increase sun-protective knowledge, attitudes, and intentions, and affect behavior among children from kindergarten through eighth grade. The interventions focus on some combination of increasing application of sunscreen, scheduling activities to avoid peak sun hours, increasing availability of shade and encouraging children to play in shady areas, and encouraging children to wear sun-protective clothing. It should be noted, however, that increased sunscreen use alone, while useful as part of a healthy sun-protective behavior regimen, is not considered to be sufficiently protective to justify a Task Force recommendation.
Outdoor recreation settings
Interventions in recreational or tourism settings are designed to increase sun-protective knowledge, attitudes, and intentions, and affect behaviors among adults and children. Interventions may include one or more of the following:
- Educational brochures (e.g., culturally-relevant materials, photographs of skin cancer lesions)
- Sun-safety training for, and role-modeling by, lifeguards, aquatic instructors, and recreation staff
- Sun-safety lessons, interactive activities, and incentives for parents and children
- Increasing available shaded areas
- Provision of sunscreen
- Point-of-purchase prompts