Cancer screening rates are lower for people living in rural areas compared with those living in urban areas. Because adherence to guideline-based screening for breast, cervical, and colorectal cancer is known to decrease mortality, interventions to improve screening rates have the potential to address the disparate cancer mortality experienced by rural women. They can also lead to a cost savings, by preventing or finding and managing cancers at earlier stages. Researchers assessed the comparative effectiveness of two remotely delivered, tailored interventions and usual care in terms of increased adherence among rural women to breast, cervical, and colorectal cancer screening that was not up to date at baseline, as well as cost-effectiveness.
Women ages 50 to 74 years who had no previous cancer diagnosis, were from rural areas, spoke English, and weren't up to date on one or more guideline-based cancer screenings (breast, cervical, or colorectal) were recruited for the study. The final sample of 963 women (mean age, 58.6 years) were randomly assigned to one of two interventions-a mailed, interactive DVD with messages tailored to each woman's responses or the DVD followed by a telephone call from a patient navigator (DVD/PN)-or usual care.
At 12 months, women who received the DVDs had nearly twice the odds of women in the usual care group of being up to date with all cancer screenings, and those in the DVD/PN group were nearly six times more likely to be up to date for all cancer screenings compared with the usual care group. The DVD/PN intervention, but not the DVD alone, was significantly more effective than usual care for promoting up-to-date screening for any of the cancers. Cost-effectiveness per participant who was up to date with all needed screening tests amounted to $14,462 in the DVD group and $10,638 in the DVD/PN group.
The study sample was highly educated and mostly White, and it's unknown if the results are applicable to other populations. Also, an online version of the intervention will be needed to replace outdated DVD technology.
The authors conclude that remotely delivered interventions targeting any or all needed screenings simultaneously could increase cancer prevention and early detection in rural women and reduce health disparities.