Efficacy of interventions for women-based cancer screenings

Efficacy of interventions for women-based cancer screenings | Image Credit: © Tyler Olson - © Tyler Olson - stock.adobe.com.

In patients with at least 1 out of date recommended cancer screening for breast, cervical, or colorectal cancer, interventions designed to increase adherence to screening tests are more effective than standard treatment, according to a recent study published in JAMA Network Open.

Rural screening rates have fallen short of Healthy People 2030 goals for breast, cervical, and colorectal cancer, despite reduced mortality from screening adherence. Individuals in rural areas with under 10,000 residents have a crude cancer mortality rate 12 points higher than individuals in large metropolitan areas.

Sociodemographic factors influencing cancer screening rates include lower educational attainment, less screening knowledge, lower income, poor health care access, and greater social deprivation. Interventions could increase screening adherence and reduce the disparate cancer mortality seen among women living in rural areas.

To evaluate the effects of increased guidance on breast, cervical, and colorectal cancer screenings, investigators conducted a randomized clinical trial. Participants were recruited from 98 rural counties from October 20, 2016, to March 15, 2019. 

Inclusion criteria included being aged 50 to 74 years, biological female sex, not up to date with 1 or more guideline-based cancer screening for women, able to speak English, not having a prior cancer diagnosis, and providing consent.US Preventive Task Force (USPSTF) data was used to determine if participants were up to date on cancer screenings.

In one intervention group, participants received an interactive DVD which allowed them to respond to prompts and receive feedback to encourage needed screenings. Information was provided based on the patient’s age, perceived cancer risk, family history of cancer, and barriers, benefits, and self-efficacy related to screening behavior.

A DVD/PN group saw women receiving a DVD similar to the DVD group, then a patient navigator telephone attempt within the following 4 weeks. Patient navigators included 2 Ohio residents who were social workers, trained by study investigators to be patient navigators.

Participants were randomly assigned to a DVD group, a DVD/PN group, or a usual group. Outcome data was collected through self-report and medical record review verification 12 months after DVD mailing. Screening tests at 12 months based on USPSTF guidelines were considered up to date.

At baseline and 12 months, participants reported sociodemographic and health care variables, cancers and recommended screening knowledge, smoking status, health beliefs, and plans to update screenings. Likert response options were used to evaluate knowledge and health beliefs for cancer screenings.

There were 963 participants in the final analysis, with a mean age of 58.6 years. A high school education level or less was reported by 16%, some college by 38%, and college or higher by 46%. Most participants were White, married, had an annual household income of $40,000 or more, and had health insurance.

Being up to date with all 3 cancer screenings at 12 months was seen in 10% of patients in the usual care group, 15% in the DVD group, and 30% in the DVD/PN group in an unadjusted model. The rates for being up to date with any 1 of 3 cancer screenings were 25%, 29%, and 49%, respectively. 

These results showed a significant increase in women being up to date on screenings in the DVD/PN group. The DVD/PN group also saw a significant increase in efficacy where the DVD group did not in a covariate-adjusted model.

In another adjusted model, significant increases were observed in both the DVD and DVD/PN groups, with the DVD group having almost twice the odds of being up to date on all 3 screenings as the usual care group, and the DVD/PN groups having almost 6 times the odds of being up to date.

A significant association was found between screening status at baseline and status at 12 months. Being up to date with at least 1 cancer screening at baseline was associated with increased odds of being up to date on all screenings at 12 months. 

Odds of being up to date at 12 months were also increased in patients aged under 65 years, planning to obtain a cancer screening within 6 months at baseline, with higher baseline self-efficacy scores, and with lower area deprivation index scores.

Overall, being up to date with breast, cervical, and colorectal cancer screenings was more often seen in intervention groups, indicating interventions designed to increase screening adherence are effective. Investigators concluded there is potential for implementing evidence-based interventions in remote midwestern US settings.

Reference

Champion VL, Paskett ED, Stump TE, et al. Comparative effectiveness of 2 interventions to increase breast, cervical, and colorectal cancer screening among women in the rural US: A randomized clinical trial. JAMA Netw Open. 2023;6(4):e2311004. doi:10.1001/jamanetworkopen.2023.11004