Assessment of barriers to cancer screening and interventions implemented to overcome these barriers in 27 Latin American and Caribbean countries

• Published in: International journal of cancer 2024-08, Vol.155 (4), p.719-730
• Main Authors: Mosquera, Isabel, Barajas, Clara B., Theriault, Hannah, Benitez Majano, Sara, Zhang, Li, Maza, Mauricio, Luciani, Silvana, Carvalho, Andre L., Basu, Partha
• Format: Article
• Language: English
• Subjects: barriers; Cancer; Cancer screening; Caribbean; Caribbean Region - epidemiology; Early Detection of Cancer - statistics & numerical data; Female; Health care; Health Services Accessibility; Humans; Information systems; Intervention; Latin America; Medical screening; Neoplasms - diagnosis; Neoplasms - prevention & control; Quality assurance
• ISSN: 0020-7136; 1097-0215
• DOI: 10.1002/ijc.34950

There is a gap in the understanding of the barriers to cancer screening participation and complying with downstream management in the Community of Latin American and Caribbean states (CELAC). Our study aimed to assess barriers across the cancer screening pathway from the health system perspective, and interventions in place to improve screening in CELAC. A standardized tool was used to collect information on the barriers across the screening pathway through engagement with the health authorities of 27 member states of CELAC. Barriers were organized in a framework adapted from the Tanahashi conceptual model and consisted of the following dimensions: availability of services, access (covering accessibility and affordability), acceptability, user–provider interaction, and effectiveness of services (which includes governance, protocols and guidelines, information system, and quality assurance). The tool also collected information of interventions in place, categorized in user‐directed interventions to increase demand, user‐directed interventions to increase access, provider‐directed interventions, and policy and system‐level interventions. All countries prioritized barriers related to the information systems, such as the population register not being accurate or complete (N = 19; 70.4%). All countries implemented some kind of intervention to improve cancer screening, group education being the most reported (N = 23; 85.2%). Training on screening delivery was the most referred provider‐directed intervention (N = 19; 70.4%). The study has identified several barriers to the implementation of cancer screening in the region and interventions in place to overcome some of the barriers. Further analysis is required to evaluate the effectiveness of these interventions in achieving their objectives. What's new? Evidence on the barriers to participation across the cancer screening pathway is limited in the Latin American and Caribbean region, and comes mainly from household surveys, which provide insight from a population perspective. In this survey of screening program managers from 27 countries, the most common reported barriers were related to the effectiveness of the services. All countries reported major barriers at the information system level, such as an inadequate population register hindering the identification and invitation of eligible population. Over 75% of the countries also reported non‐availability of services as a main barrier.