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Cancer Screening: Reducing Structural Barriers for Clients – Breast Cancer


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., 7 studies, search period 1966-2004) combined with more recent evidence (1 study, 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 – Breast Cancer [PDF - 251 kB].


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Summary of Results

Results of the Original Review

The original breast cancer screening review included seven studies.

  • Mammography screening: median increase of 17.7 percentage points (interquartile interval [IQI]: 11.5 to 30.5 percentage points).

Results of the Updated Review

One additional study qualified for the updated review.

  • Mammography screening: increase of 18 percentage points
  • Clinical breast examinations: increase of 34 percentage points



Summary of Economic Evidence

Six studies qualified for the review. Monetary values are presented in 2009 U.S dollars.

  • Cost per woman screened from a mobile mammography program ranged from $63.09 to $150.50, depending on the number of women screened and the year of program operation (4 studies). Due to one-time, fixed costs associated with program implementation, the first year of program operation is generally more expensive.
  • One study found the benefits of mobile screening outweighed the costs when distances traveled were greater than 15 miles.
  • Another study reported the cost per additional screening was $208 for mobile film mammography and $267 for mobile digital mammography.


The Task Force recommendation should apply across a range of populations and settings, provided that the program is adapted to the target population and delivery context.

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 from the updated search period evaluated a 1-day community celebration in Hawaii with personalized recruitment, one-on-one “talk story” education sessions, and culturally relevant education brochures. Other health issues also were discussed (e.g., prostate and colorectal cancer screening).