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Abstract
Certain minorities in the US are disproportionately burdened with higher cancer incidence and mortality rates. Programs encouraging timely uptake of cancer screening measures serve to reduce cancer health disparities. A systematic literature review was conducted to assess the effectiveness and the qualities of these programs, and to elucidate characteristics of success programs to aid in designing of future ones. We focused on community-based programs rather than clinic-based programs as the former are more likely to reach disadvantaged populations, and on prevention programs for breast, cervical, and/or colon cancers as longstanding screening recommendations for these cancers exist. PubMed, CINAHL and EBSCO databases were searched for articles that utilized community organizations and community health workers. Fourteen programs described in 34 manuscripts were identified. While 10 of 14 programs reported statistically significant increases in cancer prevention knowledge and/or increase in screening rates, only 7 of them enrolled large numbers of participants [defined as ≥1000]. Only 7 programs had control groups, only 4 programs independently verified screening uptake, and 2 programs had long-term follow-up [defined as more than one screening cycle]. Only one program demonstrated elimination of cancer health disparity at a population level. While most community-based cancer prevention programs have demonstrated efficacy in terms of increased knowledge and/or screening uptake, scalability and demonstration in reduction at a population level remain a challenge.
Introduction
The overall incidence and mortality for many cancers are declining. However, cancer disparities in the United States [US] exist for certain ethnic minorities [Zonderman et al., 2014], women [McKinney and Palmer, 2014], sexual minorities [Quinn et al., 2015], and in populations with lower health literacy and socioeconomic status [SES] [Bastani et al., 2015]. Cancer disparities are multifactorial and reflect an interplay between access to healthcare resources, SES, genetic constitution, environmental exposures, cultural background, behaviors associated with high risk of cancers, stress, and most notably, level of utilization of cancer screening measures [National Cancer Institute, n.d.; Siegel et al., 2018]. The community-based participatory research [CBPR] approach has been widely adopted in cancer prevention programs to address lower cancer screening uptake among racial/ethnic minorities. Community health workers [CHWs] were almost always deployed to reach these vulnerable and hard to reach populations. A study of low SES individuals in a Baltimore, MD, US smoking cessation program achieved a 23.7% 12-week quit rate in a community-based program, compared to 9.4% in a clinic-based program [Sheikhattari et al., 2016], supporting the idea that community-based programs may reach target minorities more efficiently than clinic-based programs. However, characteristics of CBPR-based cancer prevention programs that contribute to screening uptake are not well understood.
Therefore, to identify features of successful CBPR-based cancer prevention programs, we conducted a systematic literature review focusing on community-based cancer prevention programs in order to study programs that are more likely to reach disadvantaged populations. We focused on programs promoting prevention of breast, cervical, and colorectal cancers, as general population screening guidelines have been available for many years. The programs identified by the systematic literature review were evaluated in terms of significance of the results, sample size, verification of results, length of follow-up, the presence of control groups, and whether population-level reductions in disparity were demonstrated. While most programs demonstrated significant increases in cancer prevention knowledge and/or uptake in screening, scalability and demonstration in reduction of disparity at a population level remain a challenge.
Section snippets
Materials and methods
We selected studies which utilized community organizations and CHWs in order to focus on an underserved population experiencing barriers for cancer screening uptake. A literature search was conducted in 2020 using PubMed [content coverage from 1946 to the current year], CINAHL [content coverage from 1937 to the current year], and other databases covered under EBSCO. The search terms utilized were “Cancer prevention and early detection and community health workers”, “community based
Programs identified in the systematic review
A literature search of PubMed, CINAHL and EBSCO databases, and other sources yielded 655, 75, 79, and 29 articles, respectively, for a total of 838 identified articles. After removing 177 duplicates and excluding 429 articles not targeting a healthy population or targeting cancer types outside the focus of this review, 232 articles were assessed for eligibility. After excluding 198 articles whose cancer prevention programs were not conducted in a community setting [i.e., programs performed in
Conclusions
In conclusion, most of the community-based cancer prevention programs surveyed in this review have demonstrated efficacy, and programs not demonstrating efficacy still provide useful insight as to other facets of CBPR-based programs, such as CHW training and retention. Educational materials alone are difficult to increase screening rates; however, the addition of in-person didactic sessions or navigation services can increase a program's efficacy. We only found a few programs that incorporated
Financial disclosure
No financial disclosures were reported by the authors of this paper.
Declaration of competing interest
None of the authors have any conflicts of interest to disclose. This work was supported in part by the Arkansas Biosciences Institute [the major component of the Tobacco Settlement Proceeds Act of 2000], the Drs. Mae and Anderson Nettleship Endowed Chair of Oncologic Pathology, the UAMS Translational Research Institute [U54 TR001629], and the National Cancer Institute [R01 CA143130]. The supporting funding sources had no involvement in study design; collection, analysis, and interpretation of
Acknowledgements
The views presented in this study are those of the authors, and do not necessarily represent those of the National Cancer Institute, the National Institutes of Health, nor the Department of Health and Human Services. The funding sources for this study were the Arkansas Biosciences Institute [the major component of the Tobacco Settlement Proceeds Act of 2000, Award Number AWD00053655], the Drs. Mae and Anderson Nettleship Endowed Chair of Oncologic Pathology [Project Number 30014251], the
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