Offering cervical and colorectal cancer screening at breast cancer screening found effective

Offering cervical and colorectal cancer screening at breast cancer screening found effective | Image Credit: © Konstantin Yuganov - © Konstantin Yuganov - stock.adobe.com.

Coverage for cervical cancer (CC) and colorectal cancer (CRC) screening is increased by offering self-sampling to women overdue when they attend breast cancer (BC) screening, according to a recent study published in PLOS Medicine.

BC, CC, and CRC screening are recommended to decrease cancer-related morbidity and mortality. However, high participation is necessary for efficacy, and many cancer screening programs experience poor rates of participation.

Temporary impediments or forgetfulness is a common reason for lack of participation in screening programs, indicating a need for interventions to reduce these and other barriers. An example of an intervention to increase cancer screening rates is the provision of self-sampling kits and offering multiple interventions at the same time.

Research has indicated improved participation in other screening programs from initial participation in 1 screening program. Therefore, BC screening may be an opportunity to provide women with self-sampled CC and CRC screening.

Investigators conducted a study to determine whether BC screening provides an opportunity to offer self-sampled CC and CRC screening to overdue women. The trial was conducted in the central Denmark region (CDR), where BC screening is offered biennially to women aged 50 to 69 years.

In the CDR, CC screening is offered to women aged 23 to 64 years, with those aged 50 to 64 years offered screening every 5 years. Cervical cytology sampling can be given during a pelvic examination with a general practitioner, after which samples are evaluated for high-risk HPV types.

CRC is offered biennially to women aged 50 to 74 years through a fecal immunochemical test (FIT). Samples are evaluated for hemoglobin with a cutoff value of 100 ng.

Study participants included women attending BC screening in the CDR during intervention days. Only women aged 50 to 64 years received the CC screening intervention and only those with their first CRC screening invitation more than 4 and a half months before BC screening received the CRC intervention.

On intervention days, only 1 of 5 screening units hosted the intervention, leading to 1:4 categorization. All BC screening units had 20 days of intervention and 80 of being controls. The intervention included a research assistant asking patients about their interest in having a check-up on their last day of CC or CRC screening.

HPV self-sampling was offered as an intervention to overdue women through a vaginal brush (Evalyn Brush, Rovers Medical Devices, the Netherlands). For CRC screening, a FIT was offered for blood trace detection. Standard screening was offered to women in the control group.

Differences in CC and CRC screening coverage at 6 months were compared between the intervention and control groups as the primary outcome. This outcome was assessed among general women and those overdue for screening at the intervention date.

There were 27,116 women included in the final analysis, 5,618 in the intervention group and 21,498 in the control group. Similar age, sociodemographic factors, and screening history were reported between groups. Being overdue for screening at baseline was reported in 8.6% of the intervention group and 8.2% of the control group.

An increase in screening coverage in the intervention group to 88.3% was reported at 6 months following the intervention. This indicated a 4.8% higher increase than observed in the control group.

In the intervention group, 32% of overdue women participated in CC screening vs 6.1% in the control group. Increases compared to the control group were 26.9% for under-screened women vs 24.1% for unscreened women. Self-sampled screening was reported by 83.6% of women.

Similar coverage between groups at baseline was also reported for CRC screening. The increase at 6 months was 3.8% more in the intervention group than the control group, rising to 79.8%.

CRC screening participation was reported among 23.8% of overdue women in the intervention group vs 8.9% in the control group. For under-screened and unscreened women, the increases in the intervention group were 18.9% and 12.2%, respectively.

These results indicated efficacy from offering check-ups on CC and CRC screening status, as well as self-sampling to overdue women, during BC screening. Investigators concluded there are benefits to integrating combined screening offers within public health services.

Reference

Helgestad A, Larsen M, Njor S, Tranberg M, Petersen L, Andersen B. Increasing coverage in cervical and colorectal cancer screening by leveraging attendance at breast cancer screening: A cluster-randomised, crossover trial. PLOS Medicine. 2024. doi:10.1371/journal.pmed.1004431