Cancer Screening: Multicomponent Interventions — Breast Cancer
Findings and Recommendations
The Community Preventive Services Task Force (CPSTF) recommends multicomponent interventions to increase screening for breast cancer. Evidence suggests multicomponent interventions lead to greater effects when they combine strategies to increase community demand for, and access to, cancer screening. The greatest effects come, however, when these two strategies are used together with the strategy to increase provider delivery of services.
Multicomponent interventions can be used to increase screening use among underserved populations. If interventions provide access to appropriate follow-up care and treatment, they may improve health for these groups.
The full CPSTF Finding and Rationale Statement and supporting documents for Cancer Screening: Multicomponent Interventions — Breast Cancer are available in The Community Guide Collection on CDC Stacks.
Intervention
Multicomponent interventions combine two or more intervention approaches reviewed by the CPSTF, or two or more interventions to reduce structural barriers.
Interventions to increase community demand: client reminders, client incentives, small media, mass media, group education, and one-on-one education
Interventions to increase community access: reducing structural barriers and reducing client out-of-pocket costs
Interventions to increase provider delivery: provider assessment and feedback, provider incentives, and provider reminders
Reducing structural barriers includes: reducing administrative barriers, assisting with appointment scheduling, setting up alternative screening sites, adding screening hours, addressing transportation barriers, providing language translation services, offering child care
About The Systematic Review
The CPSTF finding is based on evidence from 88 studies (search period January 2004 – November 2013) evaluating intervention effects on breast (33 studies), cervical (20 studies), or colorectal (56 studies) cancer screening recommended by the U.S. Preventive Services Task Force.
Summary of Results
- Multicomponent interventions increased breast cancer screening by a median of 6.2 percentage points (34 study arms)
- Interventions using all three strategies increased cancer screening by a median of 24.2 percentage points (5 study arms)
- Interventions using strategies to increase community demand and access increased cancer screening by a median of 11.2 percentage points (48 study arms)
- Interventions that used five or more approaches showed larger increases than interventions with fewer approaches
- Providing language translation services led to largest increase (median 62.7 percentage points, 4 studies)
- Addressing transportation needs led to next largest increase (median 18.4 percentage points, 11 studies)
Summary of Economic Evidence
A systematic search (search period January 2004 – January 2018) identified 53 studies, 9 of which focused only on breast cancer screening. All monetary values reported in 2016 U.S. dollars.
- Median intervention cost per participant: $26.69 (17 study arms)
- Median cost per participant for interventions that increased community demand: $1.49 (5 study arms)
- Median cost per participant for interventions that increased community demand and access: $44.83 (11 study arms)
- Median incremental cost per additional woman screened: $147.64 (10 study arms)
- No studies reported incremental cost per QALY gained
Evidence Gaps
- What are intervention effects on repeat cancer screening rates?
- How effective are interventions that only include strategies to increase community access and provider delivery?
- What is the magnitude of effect for multicomponent interventions that provide language translation services, and does it vary across population subgroups?
- What are the effects of specific combinations of intervention approaches?
- How well do interventions work among people who have low health literacy?
- How cost-effective are these interventions?
- What specific activities were used as part of an intervention approach?
- How were structural barriers reduced?
- Who delivered the intervention approaches?
- Who were the study participants (e.g., demographic characteristics including income and health insurance status)?
Implementation Considerations and Resources
When designing and implementing multicomponent interventions, consider:
- Local population, needs, and context
- Cost and resource requirements, particularly for intensive or large-scale interventions
- Combining approaches from all three strategies shows greatest effect
- Interventions with five or more approaches show larger median increases
- Language translation services for largely non-English speaking populations
- Transportation services to populations without ready access to healthcare
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 objectives related to this CPSTF recommendation.