Sammendrag
Background: Colorectal cancer (CRC) has a significant burden in global cancer incidence and mortality despite being preventable by means of screening. Within cancer incidence and mortality, there are social inequalities. European CRC screening faces challenges in overall participation in combination with a disparaging social gradient, and prior CRC delivery intervention literature has been USA centric. This systematic review aimed to identify and assess delivery interventions in European CRC screening programs to promote CRC screening participation, especially for those of lower socioeconomic backgrounds.
Methods: This systematic review searched four databases in February 2023 without language and publication date restrictions. Articles were later excluded if they were published before 2013 and in a foreign language. Data extraction and rating of study quality were checked by an independent reviewer. Due to heterogeneity concerns, data synthesis was done by means of narrative synthesis.
Results: 18 studies met the inclusion criteria. All studies were conducted in high income European settings. The interventions in the studies mainly reported positive outcomes for CRC screening uptake. They focused on three areas of CRC cancer screening: interventions within primary screening for the general population, interventions for nonadherent individuals in the target population, and interventions for follow-up to positive results. The interventions extended the role of general practitioners, improved invitation strategies, and allowed for more choice in screening modality. Despite these interventions and increased utilization, social disparities in CRC screening participation continued to persist.
Conclusion: The results suggest that delivery interventions in European CRC screening settings are effective at increasing participation but not at improving social disparities in utilization. Additional CRC screening program development and research are needed in Eastern and Southern Europe. Moreover, interventions need to be developed and evaluated to better improve the social disparities in screening uptake. Still, this study provides data for evidence-based policy making for European stakeholders and supports the UN Sustainable Development Goals 3 and 10.
Keywords: colorectal cancer, cancer screening, delivery interventions, social inequalities, Europe