Mammogram participation ups screening rates for other cancers: Study

High rates of engagement with breast cancer screening have been successfully used to bolster participation on other screening programs, a study has found.
 
New Danish research has revealed women are much more likely to follow up with cervical and colorectal cancer screening when they are prompted to do so while at a mammogram appointment.
 
They say this simple, individualised prompt can be used by healthcare professionals to increase screening participation.
 
The intervention was particularly successful among those who were unscreened or under-screened in the other available programs. 
 
For the study, researchers conducted a randomised controlled trial including 27,116 women aged 50–69 years old who were attending a breast cancer screening.
 
Of these women, 5618 received an intervention offering self-sampled cervical or colorectal cancer, if they were overdue and within the eligible age range.
 
Ultimately, this intervention proved effective in increasing coverage with 4.8 percentage points in cervical cancer screening and 3.8 percentage points in colorectal cancer screening, compared to the control group.
 
‘Especially, among the unscreened women, 27.9% participated in cervical cancer screening and 19.7% participated in colorectal cancer screening,’ the authors concluded.
 
‘This is highly relevant, as unscreened women may benefit the most, given their elevated risk of having undetected disease or disease precursors.’
 
Reassuringly, the intervention did not have negative impacts on participants’ experience, and follow-up with health services by participants when their ‘piggy backed’ screening intervention yielded a positive result was high.
 
‘A high compliance to further clinical follow-up in the event of positive test results is also mandatory to derive benefits from the intervention. In our trial, almost all individuals with positive test results underwent relevant follow-up.’ 
 
Chair of RACGP Specific Interests Cancer and Palliative Care, Associate Professor Joel Rhee, told newsGP he believes a similar technique could be introduced into a general practice setting.
 
Given the study’s ability to increase participation in those who were previously under-screened, he said that is the group which stands to benefit the most from intervention.
 
‘There’s definitely a social determinants of health aspect to that, so it’s really important that we look at addressing that,’ Associate Professor Rhee said.
 
‘There may be socioeconomic disadvantage, there might be issues relating to communication, people from cultural or linguistically diverse backgrounds may be more likely to be under-screened or [to have] never had cancer screening.
 
‘Aboriginal and Torres Strait Islander populations may also be experiencing under-screening as well.’
 
According to the Australian Institute of Health and Welfare, Australian participation rates in cervical screening are around 68%, higher than both breast and bowel cancer screening, which sit at around 50% and 40% respectively.
 
Cervical screening rates are highest among younger women, particularly those under 40 years compared with those in the 50–74 years age group, which is the group breast and bowel cancer screening is targeted to.
 
Dr Katrina Tiller, Chair of RACGP Specific Interests Breast Medicine, told newsGP that if women start participating in screening programs in their 40s and early 50s, they will keep going for a lifetime.
 
‘Rhythms are really important in life, our rhythms can make a big difference to what we do, so getting into those rhythms is a good thing,’ she said.
 
‘Looking at the Danish study, they send their mammogram invitations with a pre-booked appointment, so the women don’t actually have to do anything, they just have to turn up.
 
‘Having an appointment might just tip some more people in because they can go to work and say, “Oh, I’ve been sent my appointment”.’
 
Associate Professor Rhee said, in Australia, bowel and breast cancer screening occur through a national program, either at home or at specific breast screen sites.
 
However, cervical cancer screening is largely undertaken in general practice and is therefore the program Australian GPs have the most interaction with. 
 
‘I suspect that these patients are also likely to [benefit from being] screened for other conditions than cervical cancer,’ Associate Professor Rhee said.
 
‘Imagine if we did the same thing in general practice … monitor patients coming into general practice for their regular appointments and then identify people who might be due for screening and then approach them and ask them to take part.
 
‘I suspect that’s going to be highly effective as well.’ 
 
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breast cancer cancer screening cervical cancer colorectal cancer mammogram