Cancer

The first article in the supplement introduces the scope of intervention research and related studies concerned with improving adherence to cancer screening tests. Much has been learned regarding the demographic, psychosocial, and health system factors that influence screening uptake, as well as how to design interventions that effectively promote adherence. The lessons from this extensive knowledge base should inform future directions for research.

The current article discussed several characteristics of behavioral and social science research on cancer screening. The priorities of applied cancer screening draw on information from registry-based surveillance of morbidity and mortality, studies that identify groups at risk of lower screening, and a perspective that emphasizes redressing disparities in screening utilization. It is important for items assessing cancer screening to become standard in population-level surveys, as well as for screening goals to be a part of national health promotion priorities. Research on future screening modalities will benefit from the expertise and methodologies developed over the past 30 years.

The current article discusses methodologic issues in conducting behavior modification interventions incancer screening research.

For this report, the authors reviewed the nature and quality of evidence to date in community-based cancer screening intervention research using a focal point framework. Thirteen lessons learned are presented.

This article summarizes, in accordance with an ecologic framework, an extensive literature concerning the factors at the public policy level, the organizational system and practice setting level, the provider level, and the patient level. It summarizes lessons learned from health care setting-based interventions to improve screening for breast, cervical, and colorectal cancers.

The current study presented lessons learned, on the basis of the published literature in the area, regarding interventions to increase diagnostic follow-up of abnormal findings resulting from cancer screening. A conceptual framework was introduced to synthesize the research findings to date and to guide future directions.

Within a population, cancer screening may be organized, opportunistic, or both. Organized screening is distinguished from opportunistic screening primarily on the basis of how invitations to screening occur—organized systems issue invitations based on centralized population registers, whereas opportunistic systems issue invitations during visits for care. The current article outlined key differences between organized and opportunistic screening, including eligibility requirements, quality assurance, follow-up, attention to cost-effectiveness, evaluation, and differences in intervention research. The authors identified lessons that were learned from comparing approaches to population screening in various countries. They argued that although cancer screening is vulnerable to shortcomings at any of the numerous steps in the process, when both models are adequately resourced, organized screening is better suited to yield the fullest benefit with respect to early cancer detection.

For this report, informed decision making (IDM) was reviewed as it relates to cancer screening. IDM interventions have improved individuals' beliefs and risk perceptions. Its impact on screening uptake varies. Evidence is limited regarding many aspects of IDM, and more research is needed. If IDM is to occur in practice on a regular basis, then clinicians will need evidence-based tools that fit within the context of modern practice.

The current article focuses on lessons learned regarding the cost-effectiveness of interventions and policies aimed at promoting cancer screening. Because the promotion of screening cannot be cost-effective if the screening strategy itself is not cost-effective, the authors also discuss the cost-effectiveness of screening. The lessons discussed may help to inform decisions regarding the ways in which health improvements generated by a given investment can be enhanced. Nonetheless, despite the conceptual attractiveness of cost-effectiveness analyses for such purposes, the available empiric data remain sparse, and much more research is necessary.

Disseminating evidence-based cancer screening interventions into practice requires collaboration among researchers, health care providers, funding agencies, and policy makers. Researchers also must take dissemination into consideration and involve other stakeholders, beginning in the earliest stages of intervention development.

The concluding article in the current supplement provides research recommendations based on consistent themes identified in the preceding articles.