Interventions to enhance cancer screening

Abstract

Although major advances have been made in the proportion of women who have been screened for breast and cervical cancer, there are still large numbers of women who are not being screened on schedule. This article includes a very selective review of types of interventions that have been used to increase cancer screening. These include the following kinds of interventions: mass media, patient-directed, provider- and system-directed, access-enhancing, community-directed, policy level, and multilevel interventions. Several different kinds of interventions have been used to increase cancer screening. The most extensive research has been conducted in the areas of breast and cervical cancer screening. Some relatively simple and inexpensive interventions have been shown to double or triple the odds that women will get screened; these include simple reminder letters or cards and telephone counseling. Tailored interventions are a new area and hold promise. Some studies have shown the value of access-enhancing strategies, such as the use of mobile vans. Policy changes are necessary but are not sufficient to increase the use of screening. One of the challenges for the future is to reach the groups in the population that have remained resistant to screening despite numerous messages in the mass media. The interventions of the future should reflect what has been learned in the past, such as the importance of reminders and cues to screening and overcoming women's barriers through strategies, such as counseling. However, tomorrow's interventions also should take advantage of digital technology and other advances in communications, and interventions should be tailored to the special needs of individuals in ways that are responsive to their learning preferences, situational constraints, and life styles. Far more research is needed to address the heterogeneity of minority populations in the United States and elsewhere. At present, it is not known to what extent interventions tested among black populations will extend to other minorities.