Cancer Screening: Group Education for Clients — Breast Cancer
Findings and Recommendations
The Community Preventive Services Task Force (CPSTF) recommends the use of client reminders to increase screening for breast cancers on the basis of strong evidence of effectiveness.
The full CPSTF Finding and Rationale Statement and supporting documents for Increasing Cancer Screening: Group Education for Clients [for Breast, Cervical, and Colorectal Cancers] are available in The Community Guide Collection on CDC Stacks.
Intervention
Group education conveys information on indications for, benefits of, and ways to overcome barriers to screening with the goal of informing, encouraging, and motivating participants to seek recommended screening. Group education is usually conducted by health professionals or by trained lay people who use presentations or other teaching aids in a lecture or interactive format, and often incorporate role modeling or other methods. Group education can be given to a variety of groups, in different settings, and by different types of educators with different backgrounds and styles.
About The Systematic Review
The CPSTF finding is based on evidence from a Community Guide systematic review published in 2008 (Baron et al., 7 studies, search period 1966-2004) combined with more recent evidence (6 studies, search period 2004-2008). The systematic 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.
Study Characteristics
- Studies focused specifically on breast cancer (8 studies) or addressed multiple cancers (4 studies).
- Most studies used interactive education programs with one or more sessions intended to improve participants’ screening awareness, knowledge, and attitudes. Where specified, interventions were conducted in the U.S. and specifically targeted minority and elderly populations.
- Most programs were delivered in churches or homes within communities.
Summary of Results
Thirteen studies qualified for the updated systematic review.
- Mammography screening: median increase of 11.5 percentage points (interquartile interval [IQI]: 5.5 to 24 percentage points; 12 studies with 13 study arms)
- One study reported mixed results for mammography screening, depending on whether the results were reported at the group or individual level.
Summary of Economic Evidence
The updated search for evidence included studies about breast, cervical, or colorectal cancer screening. Only one study about breast cancer qualified for the review. Monetary values are presented in 2009 U.S dollars.
- The cost to implement the intervention for one year was estimated at $12.87 per woman educated, assuming 250 presentations were conducted with approximately 2,500 participants.
- Volunteers provided breast screening education. The majority of the program cost (80%) was for the salary of the volunteer coordinator.
Applicability
Group education interventions to increase breast cancer screening should be applicable across a range of settings and populations, provided they are adapted for a specific population and delivery context.
Evidence Gaps
The CPSTF identified several areas that have limited information. Additional research and evaluation could help answer the following questions and fill remaining gaps in the evidence base. (What are evidence gaps?)
The following outlines evidence gaps for client incentives to increase breast, cervical, or colorectal cancer screening.
- Are group education interventions that target specific groups more effective in increasing breast, cervical, or colorectal cancer screening within those groups than within untargeted interventions?
- Does effectiveness vary with intensity of education sessions or specific components included in them?
- What are the incremental effects of adding intervention components to other interventions?
- What influence do newer methods of communication (e.g., the Internet, e-mail, social media, automated interactive voice response, texting) have on intervention effectiveness?
- What is the influence of health system factors on intervention effectiveness?
- Are interventions effective for promoting colorectal cancer screening with methods other than FOBT?
- Are interventions to promote colorectal cancer screening equally effective when specific to one type of test as they are when addressing colorectal cancer screening more generally?
Implementation Considerations and Resources
- Recruitment and training of educators, quality-control measures, duration of educational sessions, travel for in-person education, and professional backgrounds of educators may influence costs and feasibility of implementation.
- Interventions may require special skills or tools to develop messages, including tailored messages.
Crosswalks
Find programs from the Evidence-Based Cancer Control Programs EBCCP website that align with this systematic review. (What is EBCCP?)
Healthy People 2030 includes the following objective related to this CPSTF recommendation.