The Elusive Goal of Maintaining Population Cancer Screening: It Is Time for a New Paradigm

The Elusive Goal of Maintaining Population Cancer Screening: It Is Time for a New Paradigm
Jeanne Mandelblatt and Diana Buist
JNCI 2010 102;14:998-999

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EDITORIAL on paper by Vernon.
(Vernon SW, McQueen A, Tiro JA, del Junco DJ. Interventions to promote repeat breast cancer screening with mammography: a systematic review and meta-analysis. J Natl Cancer Inst (2010) 102(14):1023–1039)

Behavioral interventions only increase rates by a small to moderate amount, and there is insufficient evidence to know which approaches are the most effective (2).  These results are all the more discouraging because the reviewed  studies focused on getting women to undergo only one to two repeat screening examinations and not the 12–13 biennial screenings presently recommended for average risk women aged 50–74 years (3). Even intensive counseling approaches, which included patient navigation (patient education and assistance), showed only a modest return for their high resource intensity. The most effective approaches reported by studies in this analysis appear to be reminder systems, but those studies were too heterogeneous to provide definitive evidence of superiority

From a public health perspective, there are several different potential actions in response to these results: 1) invest in more research to test additional interventions to improve repeat mammography rates,
2) use risk status to match interventions and technology and target communications rather than a "one size fits all" approach,
3) invest in research to understand how to change the structure of care to promote repeat screening,
4) devote more resources to developing better screening tests, and/or
5) use modeling to evaluate which combinations of approaches would have the greatest potential impact on reducing breast cancer mortality and use these data to guide future directions