Umbrella Review: Self-examination programmes to detect cancer, what’s the evidence?

Objectives: To gather, assess, and analyse the evidence for self-examination programmes for oral, breast, testicular, and skin cancer to inform intervention development for oral cancer.

Methods: The Joanna Briggs Institute methodology for Umbrella Reviews informed protocol development apriori. Protocol registered on PROSPERO: CRD42021285966. Electronic databases searched included: Medline, Pubmed, CINAHL, Cochrane Health Database, PROSPERO, supplemented by hand searching of reference lists and contact with experts. No language restrictions applied. Screening, data extraction, and quality assessment were carried out independently and in duplicate. Inclusion criteria: systematic reviews (SR) summarising observational or experimental studies of community-based self-examination interventions to detect cancer in adults who have never had cancer. AMSTAR-2 guided quality assessment. Due to heterogeneity of included studies, a narrative synthesis was employed.

Results: Results are reported according to PRISMA. 350 records were identified, de-duplication left 243 screened at abstract, 83 were sought for full text review, with 19 SR meeting inclusion criteria. The SR covered 199 primary studies with circa 2,460,600 participants. Eight SR focused on breast cancer, five on testicular cancer, three on skin cancer, one on oral cancer and two SR on both skin and breast cancer. AMSTAR-2 assessment found four SR to be of high quality, two of moderate quality and the remainder low or critically low. Analysis was restricted to reviews of high and moderate quality. Findings show low quality evidence across four cancer types to support self-examination. Educational interventions and personalised information on cancer risk showed some promise in increasing self-examination activity and awareness. Patient and Public Involvement (PPI) in intervention design was reported for two primary studies.

Conclusions: The quality of current evidence for self-examination programmes is low. Novel interventions for oral cancer self-examination should be tested with rigorous experimental design that is accurately reported and include patient and public involvement in intervention design.