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Cancer Screening: Reducing Structural Barriers for Clients – Colorectal Cancer by Colonoscopy or Flexible Sigmoidoscopy

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What the CPSTF Found

About The Systematic Review

The Task Force finding is based on evidence from a Community Guide systematic review published in 2008 (Baron et al., 0 studies, search period 1966-2004) combined with more recent evidence (5 studies, search period 2004-2008). The systematic review was conducted on behalf of the Task Force by a team of specialists in systematic review methods, and in research, practice, and policy related to cancer prevention and control. This finding updates and replaces the 2008 Task Force finding on Cancer Screening: Reducing Structural Barriers – Colorectal Cancer by Colonoscopy or Flexible Sigmoidoscopy [PDF - 248 kB].

Context

There is no information for this section.

Summary of Results

Of the five additional studies that qualified for the review, one reported on the mean number of colonoscopies per month, one looked at screening by colonoscopy or FOBT, and one reported on any of three testing modalities (FOBT, colonoscopy, or sigmoidoscopy). Two additional studies examined screening by FOBT and are not reported here.

  • Colorectal cancer screening by any test: median increase of 36.9 percentage points (range: 16.3 to 41.1 percentage points; 4 study arms)
  • One study reported a 9.5% relative increase in the mean number of colonoscopies per month.

Summary of Economic Evidence

An economic review of this intervention was not conducted because the Task Force did not have enough information to determine if the intervention works.

Applicability

Applicability of this intervention across different settings and populations was not assessed because the Task Force did not have enough information to determine if the intervention works.

Evidence Gaps

Each Community Preventive Services Task Force (Task Force) review identifies critical evidence gaps—areas where information is lacking. Evidence gaps can exist whether or not a recommendation is made. In cases when the Task Force finds insufficient evidence to determine whether an intervention strategy works, evidence gaps encourage researchers and program evaluators to conduct more effectiveness studies. When the Task Force recommends an intervention, evidence gaps highlight missing information that would help users determine if the intervention could meet their particular needs. For example, evidence may be needed to determine where the intervention will work, with which populations, how much it will cost to implement, whether it will provide adequate return on investment, or how users should structure or deliver the intervention to ensure effectiveness. Finally, evidence may be missing for outcomes different from those on which the Task Force recommendation is based.

Identified Evidence Gaps

The following outlines evidence gaps for interventions to reduce structural barriers to increase breast, cervical, or colorectal cancer screening.

  • Are interventions effective for promoting colorectal cancer screening with methods other than FOBT?
  • Are interventions to promote colorectal cancer screening equally effective when addressing colorectal cancer screening more generally, as when specific to one type of test?
  • 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?

Study Characteristics

The study identified in the updated search period assessed outcomes by reviewing hospital records.

Publications