Remote Outreach May Increase Uptake of and Adherence to Cancer Screenings in Females in Rural Settings

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Females in rural areas may be six times more likely to receive timely breast, cervical, and colorectal cancer screenings with remote outreach that involves interactive education and follow-up support by telephone compared with females in rural areas who don’t have remote outreach, according to a new study published by Champion et al in JAMA Network Open. The new findings suggest that remotely delivered, targeted outreach to females in this difficult-to-reach population may be highly effective at relatively modest cost.


While evidence-based screenings exist for breast, cervical, and colorectal cancer, screening adherence remains lower than expected—particularly among historically at-risk populations such as rural communities, minorities, and individuals with a lower level of education and income.

“[Patients] are dying every day of cancers that could have been prevented or detected in precancerous stages with timely cancer screening. This is not a new problem—but it is one of paramount importance to reduce the burden of cancer in our country, especially among those who are historically at increased risk due to socioeconomic factors,” explained co–lead study author Electra Paskett, PhD, MSPH, Professor and Director of the Division of Cancer Prevention and Control and the Marion N. Rowley Chair in Cancer Research at the College of Medicine; as well as Associate Director of Population Sciences and Community Outreach, Co-Leader of the Cancer Control Program, and Director of the Center for Cancer Health Equity at The Ohio State University Comprehensive Cancer Center–Arthur G. James Cancer Hospital and Richard J. Solove Research Institute.

Study Methods and Results

In the new Rural Interventions for Screening Effectiveness (RISE) study, the researchers recruited 983 females aged 50 to 74 years from 98 rural counties and evaluated the efficacy of outreach methods designed to increase cancer screening adherence among these individuals—who often live with limited access to health-care services. The researchers noted that the study participants had no previous cancer diagnoses and were not up to date on one or more of the evidence-based screenings recommended by the U.S. Preventive Services Task Force.

The researchers randomly assigned the individuals to one of three intervention groups:

  • Usual care involving no interventions except study newsletters
  • An interactive DVD with prompts to personalize educational information for recipients about screening tests as well as information to schedule screenings
  • The same interactive DVD but with additional follow-up support calls from patient navigators with the intent to answer additional questions, address barriers to screenings, and directly assist with scheduling.

After conducting the follow-ups, the researchers discovered that the combination of a remotely delivered interactive DVD and patient navigation services may have been a highly effective and relatively low-cost way to improve cancer screening rates among females in rural areas. Specifically, while all of the individuals who received the DVD intervention were twice as likely to become up to date with all screenings, those who also received patient navigation support were almost six times more likely to have obtained all three screenings compared with those in the usual care group.


“[The] results of this study yield important data to carry out interventions that increase cancer screenings in [females in rural areas],” said co–lead study author Victoria Champion, PhD, RN, the Distinguished Professor of Nursing and the Edward and Sarah Stam Cullipher Endowed Chair at the School of Nursing as well as Associate Director of Community Outreach and Engagement and Population Science at the Melvin and Bren Simon Comprehensive Cancer Center at Indiana University. “First, it is possible and effective to combine interventions that support breast, cervical, and [colorectal] cancer screening yielding a holistic approach to early detection of cancer. Secondly, we have technology available to overcome previous barriers such as rurality and access to care. Finally, this holistic approach to cancer prevention and screening could be adapted to other behaviors that would also serve to reduce our national cancer burden,” she reported.

“Compared to treating cancer, the costs of each intervention to bring [females] up to date with screenings were relatively modest. The average cancer treatment costs $150,000 per patient in the [United States], so the additional costs required for…patient navigators to improve screenings likely can result in cost savings by avoiding cancer deaths or treatment at more advanced stages,” the researchers concluded.

Disclosure: For full disclosures of the study authors, visit

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