Cancer Screening: Small Media Targeting Clients – Colorectal Cancer
Summary of CPSTF Finding
The CPSTF has related findings for small media specific to the following:
- Breast cancer (recommended)
- Cervical cancer (recommended)
CPSTF Finding and Rationale Statement
About The Systematic Review
The review was conducted on behalf of the CPSTF by a team of specialists in systematic review methods, and in research, practice, and policy related to cancer prevention and control.
Summary of Results
Seven studies on interventions to increase colorectal cancer screening by FOBT were included in the systematic review.
- Proportion of study participants completing screening by FOBT: median increase of 12.7 percentage points (Interquartile interval: 0 to 26.4 percentage points; 8 study arms)
No studies were included for interventions to increase colorectal cancer screening by flexible sigmoidoscopy, colonoscopy, or double contrast barium enema.
Summary of Economic Evidence
Two studies qualified for the review of interventions to increase colorectal cancer screening by FOBT. Monetary values are presented in 2009 U.S dollars.
- One study reported the average intervention cost was $150 per person screened.
- One study found the cost per additional person screened was $44.49.
- Does effectiveness of small media differ by choice of medium (e.g., letter, video, brochure, or Internet-delivered application), information source (e.g., personal physician, educator), or intensity or frequency of delivery?
- What is the relative cost effectiveness of tailored versus untailored messages?
- How does the effectiveness of interventions to increase community demand for screening vary with the health literacy of a target population or subpopulation?
- How can newer methods of communication including automated telephone calls and Internet-delivered applications be used to improve delivery, acceptance, and effectiveness of these interventions?
- How effective are these interventions in increasing screening by colorectal endoscopy or by double contrast barium enema (for which no qualifying studies were identified)?
- What is required to disseminate and implement effective interventions in community settings across the United States?
- How can or should these approaches be applied to assure that screening, once initiated, is maintained at recommended intervals?
- With respect to interventions that may be tailored to individuals, how are effective tailoring programs adapted, disseminated, and implemented in community-based settings across the United States?
- Evaluated interventions used a personal record booklet; leaflets or pamphlets; videos, newsletters, or other printed materials; or a sequence of two letters.
- Studies were conducted in urban and rural populations and included study participants from both clinical and community settings.
- Of the 7 included studies, only one evaluated a tailored intervention.
Baron RC, Rimer BK, Breslow RA, et al. Client-directed interventions to increase community demand for breast, cervical, and colorectal cancer screening: a systematic review. American Journal of Preventive Medicine. 2008;35(1S):34-55.
Task Force on Community Services. Recommendations for client- and provider-directed interventions to increase breast, cervical, and colorectal cancer screening. American Journal of Preventive Medicine. 2008;35(1S):21-5.
Baron RC, Rimer BK, Coates RJ, et al. Methods for conducting systematic reviews of evidence on effectiveness and economic efficiency of interventions to increase screening for breast, cervical, and colorectal cancers. American Journal of Preventive Medicine. 2008;35(1S):26-33.
Breslow RA, Rimer BK, Baron RC, et al. Introducing the Community Guide’s reviews of evidence on interventions to increase screening for breast, cervical, and colorectal cancers. American Journal of Preventive Medicine. 2008;35(1S):14-20.
Hannon PA, Harris JR. Interventions to improve cancer screening: opportunities in the workplace. American Journal of Preventive Medicine. 2008;35(1S):10-3.
Shepherd WL, Moore A. Task Force recommendations: application in the “real world” of community intervention. American Journal of Preventive Medicine. 2008;35(1S):1-2.
Yabroff KR. Interventions to improve cancer screening: commentary from a health services research perspective. American Journal of Preventive Medicine. 2008;35(1S):6-9.
Glanz K, Melvin C. How not to get lost in translation: implementing the recommendations and identifying evidence gaps. American Journal of Preventive Medicine. 2008;35(1S):3-5.
When starting an effectiveness review, the systematic review team develops an analytic framework. The analytic framework illustrates how the intervention approach is thought to affect public health. It guides the search for evidence and may be used to summarize the evidence collected. The analytic framework often includes intermediate outcomes, potential effect modifiers, potential harms, and potential additional benefits.
No content is available for this section.
Summary Evidence Table
Summary Evidence Table – Effectiveness Review
Contains evidence from reviews of interventions to increase breast, cervical, and colorectal cancer screening
Dickey L, Petitti D. A patient-held minirecord to promote adult preventive care. J Fam Pract 1992;34(4):457-63.
Harris MA, Byles JE, Cockburn J, D’Este C. A general practice-based recruitment strategy for colorectal cancer screening. Aust N Z J Public Health 2000;24(4):441-3.
Hart A, Barone T, Gay S, et al. The effect on compliance of a health education leaflet in colorectal cancer screening in general practice in central England. J Epidemiol Community Health 1997;51:187-91.
Kramish Campbell M, James A, Hudson MA, et al. Improving multiple behaviors for colorectal cancer prevention among African American church members. Health Psychol 2004;23(5):492-502.
Lee C. A randomised controlled trial to motivate worksite fecal occult blood testing. Yonsei Med J 1991;32(2):131-8.
Powe BD. Promoting fecal occult blood testing in rural African American women. Cancer Pract 2002;10(3):139-46.
Pye G, Christie M, Chamberlain J, et al. A comparison of methods for increasing compliance within a general pracititioner based screening project for colorectal cancer and the effect on practitioner workload. J Epidemiol Community Health 1988;42:66-71.
Lairson DR, DiCarlo M, Myers RE, Wolf T, Cocroft J, Sifri R, Rosenthal M, Vernon SW, Wender R. Cost-effectiveness of targeted and tailored interventions on colorectal cancer screening use. Cancer 2008;112:779 88.
Shankaran V, McKoy JM, Dandade N, Nonzee N, Tigue CA, Bennett CL, Denberg TD. Costs and cost-effectiveness of a low-intensity patient-directed intervention to promote colorectal cancer screening. Journal of Clinical Oncology 2007;25(33):5248-53.
- Increasing Colorectal Cancer Screening and Promoting Screening Quality: An Action Guide for Engaging Employers and Professional Medical Organizations
Developed by CDC’s Division of Cancer Prevention and Control
- Increasing Colorectal Cancer Screening: An Action Guide for Working with Health Systems
Developed by CDC’s Division of Cancer Prevention and Control
To establish the evidence base the team searched five computerized databases from the earliest entries in each through November 2004: MEDLINE, database of the National Library of Medicine (from 1966); the Cumulative Index to Nursing and Allied Health database (CINAHL, from 1982); the Chronic Disease Prevention database (CDP, Cancer Prevention and Control subfield, from 1988); PsycINFO (from 1967); and the Cochrane Library databases. Medical subject headings (MeSH) searched (including all subheadings) are shown below. The team also scanned bibliographies from key articles and solicited other citations from other team members and subject-matter experts. Conference abstracts were not included because, according to Community Guide criteria, they generally do not provide enough information to assess study validity and to address the research questions.
The search identified over 9000 citations whose titles and abstracts were screened for potential relevance to interventions and outcomes of interest; of these, 580 articles were retrieved for full-text review.
Search terms used in five electronic databases to find studies for inclusion in the systematic reviews of cancer screening. Searches were conducted to find all studies of cancer screening including those specific to screening for breast, cervical, or colorectal cancer.
Neoplasms combined with any of the following headings:
- Early detection
- Mass screening
- Multiphasic screening
- Preventive health services
- Breast neoplasms
- Cervical intraepithelial neoplasia
- (Uterine) cervical neoplasms
- Cervix dysplasia
- Vaginal smears
- Colonic neoplasms
- Colorectal neoplasms
- Occult blood
- Sigmoid neoplasms
No content is available for this section.
Considerations for Implementation
- Primary barriers to implementing a small media intervention include limited resources and infrastructure.
- Access to effective marketing strategies, educational messages, and instructional materials (particularly for specific subgroups) may be limited by cost and special skills required to develop and test these messages.
- Materials libraries (such as those available at National Cancer Institute’s Evidence-Based Cancer Control Programs) are a potential source of high quality, topic- and population-specific messages developed as components of evidence-based programs.
- Production and dissemination of tailored messages may be more costly and resource intensive than untailored programs because tailoring generally requires new data collection (although electronic or other medical records could be used for some simple tailoring algorithms), development of extensive message libraries with graphics, and computer programming support to ensure appropriate individualization.
- Cost effectiveness may improve through economies of scale.
- Web-based tailored intervention programs may provide a good solution to both the cost and complexity of developing and delivering tailored interventions to promote cancer screening.
- Recruitment, training, and support of community health workers and other interventionists to deliver educational messages may pose substantial barriers in smaller community or free-standing clinical settings.
- Regional or other aggregations of populations and services might be considered as strategies to overcome this problem.
Evidence-Based Cancer Control Programs (EBCCP)
Find programs from the EBCCP website that align with this systematic review. (What is EBCCP?)
Healthy People 2030
Healthy People 2030 includes the following objective related to this CPSTF recommendation.