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What implementation interventions increase cancer screening rates? a systematic review

Melissa C Brouwers12*, Carol De Vito12, Lavannya Bahirathan12, Angela Carol3, June C Carroll4, Michelle Cotterchio5, Maureen Dobbins6, Barbara Lent7, Cheryl Levitt89, Nancy Lewis10, S Elizabeth McGregor11, Lawrence Paszat1213, Carol Rand1415 and Nadine Wathen16

Author Affiliations

1 Program in Evidence-based Care, Cancer Care Ontario, Hamilton, Ontario, Canada

2 Departments of Oncology and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada

3 Hamilton Urban Core Community Centre, Hamilton, Ontario, Canada

4 Department of Family and Community Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada

5 Population Studies and Surveillance, Cancer Care Ontario, Toronto, Ontario, Canada

6 School of Nursing, McMaster University, Hamilton, Ontario, Canada

7 Department of Family Medicine, The University of Western Ontario, London, Ontario, Canada

8 Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada

9 Primary Care, Cancer Care Ontario, Toronto, Ontario, Canada

10 Prevention and Screening, Cancer Care Ontario, Toronto, Ontario, Canada

11 Population Health Research, Alberta Health Services - Cancer Epidemiology, Prevention and Screening, Calgary, Alberta, Canada

12 Department of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada

13 Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada

14 Regional Cancer Prevention and Early Detection Network Hamilton, Niagara, Haldimand, Brant, Ontario, Canada

15 Systemic, Supportive and Regional Cancer Programs, Juravinski Cancer Centre, Hamilton, Ontario, Canada

16 Faculty of Information and Media Studies, The University of Western Ontario, London, Ontario, Canada

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Implementation Science 2011, 6:111  doi:10.1186/1748-5908-6-111

Published: 29 September 2011



Appropriate screening may reduce the mortality and morbidity of colorectal, breast, and cervical cancers. However, effective implementation strategies are warranted if the full benefits of screening are to be realized. As part of a larger agenda to create an implementation guideline, we conducted a systematic review to evaluate interventions designed to increase the rate of breast, cervical, and colorectal cancer (CRC) screening. The interventions considered were: client reminders, client incentives, mass media, small media, group education, one-on-one education, reduction in structural barriers, reduction in out-of-pocket costs, provider assessment and feedback interventions, and provider incentives. Our primary outcome, screening completion, was calculated as the overall median post-intervention absolute percentage point (PP) change in completed screening tests.


Our first step was to conduct an iterative scoping review in the research area. This yielded three relevant high-quality systematic reviews. Serving as our evidentiary foundation, we conducted a formal update. Randomized controlled trials and cluster randomized controlled trials, published between 2004 and 2010, were searched in MEDLINE, EMBASE and PSYCHinfo.


The update yielded 66 studies new eligible studies with 74 comparisons. The new studies ranged considerably in quality. Client reminders, small media, and provider audit and feedback appear to be effective interventions to increase the uptake of screening for three cancers. One-on-one education and reduction of structural barriers also appears effective, but their roles with CRC and cervical screening, respectively, are less established. More study is required to assess client incentives, mass media, group education, reduction of out-of-pocket costs, and provider incentive interventions.


The new evidence generally aligns with the evidence and conclusions from the original systematic reviews. This review served as the evidentiary foundation for an implementation guideline. Poor reporting, lack of precision and consistency in defining operational elements, and insufficient consideration of context and differences among populations are areas for additional research.