Interventions to improve cancer screening: commentary from a health services research perspective.

ased on evidence demonstrating that early detection and treatment can reduce mortality, regular screening for breast, cervical, and colorectal ancers has been widely recommended by most prevenive services organizations for the past several deades. However, use of mammography, Pap smear, nd any of the recommended colorectal cancer screenng modalities remains sub-optimal. Patients without ecent screening tend to be poor, uneducated, minorty, or without health insurance or a usual source of are. Lack of understanding of screening benefits, fear f a cancer diagnosis, concerns about inconvenience, nd forgetfulness are also associated with less screenng. Thus, interventions that address patient barriers o initiating and maintaining regular cancer screening re important public health strategies to reduce cancer orbidity and mortality. As shown in the systematic reviews conducted by aron and colleagues for the Task Force on Commuity Preventive Services (the Task Force), many categoies of patient-directed interventions are associated ith improved screening. The Task Force found suffiient evidence to recommend interventions that inrease patient demand for cancer screening, including eminders, small media with educational or motivaional information (i.e., videos and printed materials uch as letters, brochures, or newsletters), and one-onne education. The Task Force also found sufficient vidence to recommend interventions that lead to the eduction of structural or economic barriers to cancer creening and the reduction of out-of-pocket costs for t least one type of cancer screening test. This comrehensive information will be valuable for public ealth professionals and researchers in a variety of ettings. As noted in their analytic framework for assessing nterventions, screening is a necessary first step in a rocess of care, but is not sufficient for early detection nd improved outcomes. Patients who experience