Discussion
cancers, colorectal cancer, breast cancer, cancer, colorectal and breast cancer, cervical cancer, colorectal or cervical cancer
CANCERS, COLORECTAL CANCER, BREAST CANCER, CANCER, CERVICAL CANCER
The goal of this study was to compare the effectiveness of 2 interventions with usual care to increase the proportion of rural women up to date with screening for 3 cancers (breast, cervical, and colorectal). We considered the following 12-month outcomes: being up to date with all screening tests and being up to date with any needed screening tests (ie, for 1, 2, or 3 cancers depending on baseline status). Although other studies have been successful at simultaneously increasing both colorectal and breast cancer screening or cervical and breast cancer screening,Participants had greater odds of becoming up to date with all screenings if only 1 screening was needed or if breast cancer was 1 of the 2 screenings needed. Within our study, when only 1 screening is needed, it is easier for women to become up to date with all screenings. If a participant needed screening for more than 1 site, the intervention was more intense because it focused on obtaining any cancer screening test that was not up to date. Although the need for multiple screening tests could have increased the time needed for intervention activities, consolidating efforts was still more time efficient than addressing 1 needed cancer screening test at a time and probably at different times. Additionally, our baseline breast cancer screening up-to-date rates were higher than baseline rates for cervical and colorectal cancer screening, suggesting that this population of women may find it easier to become up to date with mammography vs cervical or colorectal cancer screening. Consistent with this finding, previous studies have found higher rates of breast cancer screening compared with colorectal or cervical cancer screening.Sociodemographic characteristics associated with becoming up to date with screening tests were similar to reports from previous studies.Among our theoretical measures, intention to screen, knowledge, and barriers reported at baseline were related to becoming up to date at 12 months after randomization. A participant who self-reported intention (contemplation) to screen in the next 6 months had almost 2 times the odds of becoming up to date with all needed cancer screenings, consistent with prior research based on the transtheoretical model of behavior change.The USPSTF guidelines support that cervical cancer screening not be done after 65 years of age if results in the past 3 years were negative.The DVD/PN intervention was more cost-effective in bringing participants up to date with all needed tests due to the greater effect size. Compared with treating cancer, the costs of each intervention to bring women up to date with screening were relatively modest, as on average, cancer treatment costs $150 000 per patient in the US,