Factors in quality care--the case of follow-up to abnormal cancer screening tests--problems in the steps and interfaces of care

J Natl Cancer Inst Monogr. 2010;2010(40):58-71. doi: 10.1093/jncimonographs/lgq009.


To achieve the benefit of cancer screening, appropriate follow-up of abnormal screening test results must occur. Such follow-up requires traversing the transition between screening detection and diagnosis, including several steps and interfaces in care. This article reviews factors and interventions associated with follow-up of abnormal tests for cervical, breast and colorectal cancers. We synthesized 12 reviews of descriptive and intervention studies published between 1980 and 2008. There was wide variability in definition of follow-up, setting, study population, and reported prevalence rates. Correlates of follow-up included patient characteristics (eg, knowledge and age), social support, provider characteristics, practice (eg, having reminders systems), community and professional norms (eg, quality measures), and policy (eg, federal programs). Effective interventions included patient education and support; delivery systems design changes, such as navigation; and information system changes, most notably patient tracking and physician reminders. Few studies focused explicitly on interfaces and steps of care, such as communication between primary care and specialists, or simultaneously targeted the multilevel factors that affect care. Future practice and research priorities should include development of clear operational definitions of the steps and interfaces related to patients, providers, and organizations; reflect evolving guidelines and new technologies; determine priorities for intervention testing; and improve measures and apply appropriate study designs.

Publication types

  • Research Support, N.I.H., Extramural
  • Review

MeSH terms

  • Breast Neoplasms / diagnosis*
  • Breast Neoplasms / epidemiology
  • Colorectal Neoplasms / diagnosis*
  • Colorectal Neoplasms / epidemiology
  • Continuity of Patient Care / organization & administration*
  • Delayed Diagnosis
  • Delivery of Health Care / organization & administration
  • Early Detection of Cancer* / economics
  • Early Detection of Cancer* / psychology
  • Endoscopy, Gastrointestinal / psychology
  • Endoscopy, Gastrointestinal / statistics & numerical data
  • Female
  • Health Policy
  • Health Priorities
  • Humans
  • Male
  • Mammography / psychology
  • Mammography / statistics & numerical data
  • Mass Screening / economics
  • Mass Screening / organization & administration*
  • Mass Screening / psychology
  • Occult Blood
  • Patient Care Management / organization & administration*
  • Practice Guidelines as Topic
  • Primary Health Care
  • Quality Assurance, Health Care
  • Referral and Consultation
  • Reminder Systems
  • Social Support
  • Uterine Cervical Neoplasms / diagnosis*
  • Uterine Cervical Neoplasms / epidemiology
  • Vaginal Smears / psychology
  • Vaginal Smears / statistics & numerical data