Abstract
Cancer screening guidelines recommend that women over 50 years regularly be screened for breast, cervical and colorectal cancers. Population-based screening programs use performance indicators to monitor uptake for each type of cancer screening, but integrated measures of adherence across multiple screenings are rarely reported. Integrated measures of adherence that combine the three cancers cannot be inferred from measures of screening uptake of each cancer alone; nevertheless, they can help discern the proportion of women who, having received one or two types of screening, may be more amenable to receiving one additional screen, compared to those who haven't had any screening and may experience barriers to access screening such as distance, language, and so on. The focus of our search was to identify indicators of participation in the three cancers, therefore our search strategy included synonyms of integrated screening, cervical, breast and colorectal cancer screening. Additionally, we limited our search to studies published between 2000 and 2015, written in English, and pertaining to females over 50 years of age. The following databases were searched: MEDLINE, EMBASE, EBM Reviews, PubMed, PubMed Central, CINAHL, and Nursing Reference Center, as well as grey literature resources. Of the 78 initially retrieved articles, only 7 reported summary measures of screening across the three cancers. Overall, adherence to cervical, breast and colorectal cancer screening ranged from around 8% to 43%. Our review confirms that reports of screening adherence across breast, cervical and colorectal cancers are rare. This is surprising, as integrated cancer screening measures can provide additional insight into the needs of the target population that can help craft strategies to improve adherence to all three screenings.
Highlights
Screening has been defined as “the presumptive identification of unrecognized disease or defect by the application of tests, examinations or other procedures that can be applied rapidly.”[1]
An integrated indicator of participation would go beyond each cancer to quantify women screened for two or all three cancers; unless measured, this cannot be inferred from participation in each of three cancer screenings (Fig 1)
Seven studies reported an integrated measure of participation across breast, cervical and colorectal cancer screening, three cross-sectional studies, [12,13,14] two randomized controlled trials, [15,16] an evaluation of a triple screening pilot program, [17] and a group pre-post intervention study.[18]
Summary
Screening has been defined as “the presumptive identification of unrecognized disease or defect by the application of tests, examinations or other procedures that can be applied rapidly.”[1]. Most major medical organizations [3] recommend a population approach to screening for cervical, breast and colorectal cancers for women over 50 years of age. For groups in which screening for more than one cancer is indicated (such as in women older than 50 years of age) participation in more than one cancer screening could be measured. Women between 50 and years of age, for example, are advised to undergo screening for cervical, breast and colorectal cancers, and those in the to 74 age group should be screened for breast and colorectal cancers. An integrated indicator of participation would go beyond each cancer to quantify women screened for two or all three cancers; unless measured, this cannot be inferred from participation in each of three cancer screenings (Fig 1)
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