Narrowing the Equity Gap: The Impact of Organized versus Opportunistic Cancer Screening in Catalonia (Spain)

Espinàs, Josep Alfons; Aliste, Luisa; Fernández, Esteve; Argimón, Josep M.; Tresserras, Ricard; Borràs, Josep M.

doi:10.1258/jms.2011.010086

Cited by 32 publications

(24 citation statements)

References 19 publications

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“…Opportunistic screening is not systematic, usually has lower rates of participation, higher disparities in screening uptake, and no quality assurance program. 12,13 Overdiagnosis is defined as detecting cancers that, in the absence of screening, would not present symptomatically or cause harm during the patient's lifetime. 11…”

Section: Principles Of Screeningmentioning

confidence: 99%

Early detection of melanoma: a consensus report from the Australian Skin and Skin Cancer Research Centre Melanoma Screening Summit

Janda

Cust

Aitken

et al. 2020

Australian and New Zealand Journal of Public Health

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Introduction: A Melanoma Screening Summit was held in Brisbane, Australia, to review evidence regarding current approaches for early detection of melanomas and explore new opportunities. Results: Formal population‐based melanoma screening is not carried out in Australia, but there is evidence of considerable opportunistic screening as well as early detection. Biopsy rates are rising and most melanomas are now diagnosed when in situ. Based on evidence review and expert opinion, the Summit attendees concluded that there is currently insufficient information in terms of comparative benefits, harms and costs to support change from opportunistic to systematic screening. Assessment of gains in precision and cost‐effectiveness of integrating total body imaging, artificial intelligence algorithms and genetic risk information is required, as well as better understanding of clinical and molecular features of thin fatal melanomas. Conclusions: Research is needed to understand how to further optimise early detection of melanoma in Australia. Integrating risk‐based population stratification and more precise diagnostic tests is likely to improve the balance of benefits and harms of opportunistic screening, pending assessment of cost‐effectiveness. Implications for public health: The Summit Group identified that the personal and financial costs to the community of detecting and treating melanoma are rising, and this may be mitigated by developing and implementing a more systematic process for diagnosing melanoma.

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Section: Principles Of Screeningmentioning

confidence: 99%

Early detection of melanoma: a consensus report from the Australian Skin and Skin Cancer Research Centre Melanoma Screening Summit

Janda

Cust

Aitken

et al. 2020

Australian and New Zealand Journal of Public Health

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“…In contrast, there is good evidence that proactive patient outreach improves screening rates 4,5 and at a population level, has the potential to reduce income-related inequities. 3,6,7 In a proactive approach, practices identify which patients are due for screening and reaches out to invite them for counseling.…”

mentioning

confidence: 99%

Mailed Letter Versus Phone Call to Increase Uptake of Cancer Screening: A Pragmatic, Randomized Trial

et al. 2018

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Background: There is good evidence that cancer-specific patient outreach improves rates of cervical, breast, and colorectal cancer screening. However, it is unclear how primary care practices should implement integrated outreach for all 3 types of cancer screening. We aimed to understand whether integrated outreach using mailed letters or phone calls were more effective at increasing screening uptake in a primary care organization.Method: We conducted a pragmatic randomized trial comparing outreach by mailed letter or personalized phone call for patients overdue for cervical, breast, or colorectal cancer screening. The study was conducted at 6 clinics within an academic primary care organization in Toronto, Canada. Our primary outcome was an uptake of at least 1 screening test for which the patient was overdue. Our primary analysis was an intention-to-treat, unadjusted comparison of proportions, using a 2 test. We also compared costs per additional patient screened. All analyses were stratified by sex.Results: A total of 3733 females and 1537 males were randomized to receive 1 of the interventions. Among women, 33.0% allocated to receive a reminder letter and 41.2% allocated to receive a reminder phone call received at least 1 screening test for which they were due (absolute difference, 8.1%; 95% CI, 5.1%-11.2%, P < .001). Among men, 24.8% allocated to receive a reminder letter and 28.8% allocated to a reminder phone call received screening for colorectal cancer (absolute difference, 4.1%; 95% CI, ؊0.4% to 8.5%, P ‫؍‬ .073). For women and men, the letters cost approximately CaD $5.07 and CaD $7.16, respectively, for each completed screening test compared with CaD $8.71 and CaD $12.00 for the phone calls.Conclusions: Phone calls were more effective than mailed letters at increasing uptake for cervical, breast, and colorectal cancer screening among women. However, phone calls were more expensive than letters. Primary care practices should consider integrating phone call reminders into their practice, possibly as part of a targeted or staged approach to outreach for cancer screening. (J Am Board Fam Med 2018;31:857-868.)

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“…Consequently, an improved screening coverage seems to be necessary to observe a reduction in the mortality attributable to cervical cancer. This is in line with European guidelines and other scientific societies including Spanish and Catalan ones, recommend an organized approach of ‘call and recall’ of the target population[1,11–14]. However, a recent report analyzing the situation of cervical cancer screening in Europe identified a large number of countries lacking a standardized approach for quality assurance, for monitoring or evaluation of the country based strategies to prevent cervical cancer [2].…”

Section: Introductionmentioning

confidence: 73%

Increasing Cervical Cancer Screening Coverage: A Randomised, Community-Based Clinical Trial

et al. 2017

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BackgroundOpportunistic cervical cancer screening can lead to suboptimal screening coverage. Coverage could be increased after a personalised invitation to the target population. We present a community randomized intervention study with three strategies aiming to increase screening coverage.MethodsThe CRICERVA study is a community-based clinical trial to improve coverage of population-based screening in the Cerdanyola SAP area in Barcelona.A total of 32,858 women residing in the study area, aged 30 to 70 years were evaluated. A total of 15,965 women were identified as having no registration of a cervical cytology in the last 3.5 years within the Public Health data base system. Eligible women were assigned to one of four community randomized intervention groups (IGs): (1) (IG1 N = 4197) personalised invitation letter, (2) (IG2 N = 3601) personalised invitation letter + informative leaflet, (3) (IG3 N = 6088) personalised invitation letter + informative leaflet + personalised phone call and (4) (Control N = 2079) based on spontaneous demand of cervical cancer screening as officially recommended. To evaluate screening coverage, we used heterogeneity tests to compare impact of the interventions and mixed logistic regression models to assess the age effect. We refer a “rescue” visit as the screening visit resulting from the study invitation.ResultsAmong the 13,886 women in the IGs, 2,862 were evaluated as having an adequate screening history after the initial contact; 4,263 were lost to follow-up and 5,341 were identified as having insufficient screening and thus being eligible for a rescue visit. All intervention strategies significantly increased participation to screening compared to the control group. Coverage after the intervention reached 84.1% while the control group reached 64.8%. The final impact of our study was an increase of 20% in the three IGs and of 9% in the control group (p<0.001). Within the intervention arms, age was an important determinant of rescue visits showing a statistical interaction with the coverage attained in the IGs. Within the intervention groups, final screening coverage was significantly higher in IG3 (84.4%) (p<0.001). However, the differences were more substantial in the age groups 50–59 and those 60+. The highest impact of the IG3 intervention was observed among women 60+ y.o with 32.0% of them being rescued for screening. The lowest impact of the interventions was in younger women.ConclusionsThe study confirms that using individual contact methods and assigning a fixed screening date notably increases participation in screening. The response to the invitation is strongly dependent on age.Trial RegistrationClinicalTrials.gov NCT01373723

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Narrowing the Equity Gap: The Impact of Organized versus Opportunistic Cancer Screening in Catalonia (Spain)

Cited by 32 publications

References 19 publications

Early detection of melanoma: a consensus report from the Australian Skin and Skin Cancer Research Centre Melanoma Screening Summit

Early detection of melanoma: a consensus report from the Australian Skin and Skin Cancer Research Centre Melanoma Screening Summit

Mailed Letter Versus Phone Call to Increase Uptake of Cancer Screening: A Pragmatic, Randomized Trial

Increasing Cervical Cancer Screening Coverage: A Randomised, Community-Based Clinical Trial

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