Cancer screening strategies, coverage, and participation strongly vary by country. This thesis of Senshuang Zheng evaluates the uptake and effectiveness of cancer screening in and outside China, and influencing factors at organization, provider, and participant level.
Chapter 2 and 3 were conducted in primary healthcare institutions in China and showed that colorectal cancer (CRC) screening performed better than gynecologic cancer screening due to better organization. Especially healthcare providers with positive attitudes toward screening and perceived acceptable workload were more willing to perform screening. Sufficient manpower and training for cancer screening improves performance. For factors of screening uptake and effectiveness on participant level, CRC screening was used as example.
In chapter 4 the study in Flanders (Belgium) showed that during COVID-19 pandemic, low socioeconomic status (SES) people showed greater decrease in uptake, while high SES people showed greater increase in screening interval. Systematic review of RCTs and simulation models worldwide in Chapter 5 showed that commonly used CRC screening scenarios are effective at reducing CRC-specific mortality and 10-yearly colonoscopy is the most effective. Scenarios using FIT, gFOBT, and endoscopy with high adherence presented approximately 1% all-cause mortality reduction.
We conclude that well-organized cancer screening programs should be adequately resourced to remove participation barriers. Motivating healthcare providers to perform screening services by increasing revenue and providing screening education and training promote screening quality and participation. Tailored screening should target populations with low SES to improve uptake. A cancer screening strategy that combines screening for multiple cancers may be considered to further reduce cancer-related mortality.
