Barriers and facilitators to breast and colorectal cancer screening of older adults in primary care: A systematic review

While the US Preventive Services Task Force recommends routine screening for breast and colorectal cancer, older persons remain largely under-screened. It is paramount to determine the barriers and facilitators to breast and colorectal cancer screening of older adults, from the perspectives of patients and primary care physicians (PCPs).A systematic review was conducted, searching eight databases (Medline, Web of Science, Cochrane Database of Systematic Reviews, EMBASE, CINAHL, PsychInfo, SocINDEX, Sociofile/Sociological Abstract) for articles published or in press between 2000 and August 2008.Selection of quantitative studies completed with PCPs or older adults and data extraction were conducted independently by two reviewers. A taxonomy of barriers and facilitators was created based on the studies reviewed. Based on this taxonomy, the number of studies identified for each barrier and facilitator was summarized.Most of the studies in the 42 selected articles were conducted in North America and Europe using cross-sectional designs and questionnaires. Based on our taxonomy, barriers and facilitators to cancer screening were classified in terms of the physician, the patient and the health care system. The main barriers were the PCP's lack of belief in the usefulness of cancer screening for older adults, the patients' embarrassment, discomfort or fear of the test and the lack of health care coverage for screening tests. This review suggests that interventions targeting the physician, the patient and the health care system are required to optimize breast and colorectal cancer screening in primary care.