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Long-term Results From a Randomized Controlled Trial to Increase Cancer Screening Among Attendees of Community Health Centers

¹ Department of Family Medicine, University of South Florida., Tampa, Fla
² H. Lee Moffitt Cancer Center & Research Institute, Tampa, Fla

CORRESPONDING AUTHOR: Richard Roetzheim, MD, Department of Family Medicine, University of South Florida, 12901 Bruce B. Downs Blvd. MDC 13, Tampa, FL 33612, rroetzhe{at}hsc.usf.edu

PURPOSE We assessed whether increased cancer screening rates that were observed with Cancer Screening Office Systems (Cancer SOS) could be maintained at 24 months’ follow-up, a period in which clinics were expected to be largely self-sufficient in maintaining the intervention.

METHODS Eight primary care clinics serving disadvantaged populations in Hills-borough County, Fla, agreed to take part in a cluster-randomized experimental trial. Charts of independent samples of established patients aged 50 to 75 years were abstracted, with data collected at baseline (n = 1,196) and at 24 months’ follow-up (n = 1,296). Papanicolaou (Pap) smears, mammography, and fecal occult blood testing were assessed.

RESULTS At 24 months of follow-up, intervention patients had received a greater number of cancer screening tests (mean 1.17 tests vs 0.94 tests, t test = 4.42, P <.0001). In multivariate analysis that controlled for baseline screening rates, secular trends, and other patient and clinic characteristics, the intervention increased the odds of mammograms slightly (odds ratio [OR]) = 1.26; 95% confidence interval [CI], 1.02–1.55; P = .03) but had no effect on fecal occult blood tests (OR = 1.17; 95% CI, 0.92–1.48; P =0.19) or Pap smears (OR = 0.88; 95% CI, 0.0.68–1.15; P = .34).

CONCLUSIONS The Cancer SOS intervention had persistent, although modest, effects on screening at 24 months’ follow-up, an effect that had clearly diminished from results reported at 12 months’ follow-up. Further study is needed to develop successful intervention strategies that are either self-sustaining or that are able to produce long-term changes in screening behavior.

Key Words: Mass screening • mammography • vaginal smears • occult blood • breast neoplasms • colorectal neoplasms • community health centers • primary health care

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