CoChat
Sign Up
Cited by 47Global Cancer Incidence and ScreeningWomen's cancer prevention and managementHealth Policy Implementation Science

The global role, impact, and limitations of Community Health Workers (CHWs) in breast cancer screening: a scoping review and recommendations to promote health equity for all

Open access
Hand, Taylor, Rosseau, Natalie A., Stiles, Christina E., Sheih, Tianna, Ghandakly, Elizabeth, Oluwasanu, Mojisola, Olopade, Olufunmilayo I.·2021·Global Health Action
DOI 10.1080/16549716.2021.1883336PMC PMC8079044
Open this paper in CoChat — free account

Abstract

Introduction: Innovative interventions are needed to address the growing burden of breast cancer globally, especially among vulnerable patient populations. Given the success of Community Health Workers (CHWs) in addressing communicable diseases and non-communicable diseases, this scoping review will investigate the roles and impacts of CHWs in breast cancer screening programs. This paper also seeks to determine the effectiveness and feasibility of these programs, with particular attention paid to differences between CHW-led interventions in low- and middle-income countries (LMICs) and high-income countries (HICs).Methods: A scoping review was performed using six databases with dates ranging from 1978 to 2019. Comprehensive definitions and search terms were established for ‘Community Health Workers’ and ‘breast cancer screening’, and studies were extracted using the World Bank definition of LMIC. Screening and data extraction were protocolized using multiple independent reviewers. Chi-square test of independence was used for statistical analysis of the incidence of themes in HICs and LMICs.Results: Of the 1,551 papers screened, 33 were included based on inclusion and exclusion criteria. Study locations included the United States (n=27), Bangladesh (n=1), Peru (n=1), Malawi (n=2), Rwanda (n=1), and South Africa (n=1). Three primary roles for CHWs in breast cancer screening were identified: education (n=30), direct assistance or performance of breast cancer screening (n=7), and navigational services (n=6). In these roles, CHWs improved rates of breast cancer screening (n=23) and overall community member knowledge (n=21). Two studies performed cost-analyses of CHW-led interventions.Conclusion: This review extends our understanding of CHW effectiveness to breast cancer screening. It illustrates how CHW involvement in screening programs can have a significant impact in LMICs and HICs, and highlights the three CHW roles of education, direct performance of screening, and navigational services that emerge as useful pillars around which governments and NGOs can design effective programs in this area.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1080/16549716.2021.1883336

Cites

1 of 1 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Promotora-led education programmes increased the knowledge and intention to be screened for CC and BC.

    “Promotora-led education programmes also increased the knowledge and intention to be screened for CC [51] and BC [45].”

    From Improving cancer screening uptake: A behavioural and cultural insights perspective and rapid review (2026) · cites this paper as [45]

    The Results (Study characteristics) include five studies using promotoras under the review’s CHW category, and Results (Outcomes) reports increased breast-cancer knowledge in 21 CHW-intervention studies. The cited paper does not establish that promotora-led programmes increased intention to undergo breast-cancer screening; the cervical-cancer portion of the sentence has a separate citation. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • For minority groups, using trained community members increased effectiveness.

    “For minority groups, using trained community members increased effectiveness [45,46].”

    From Improving cancer screening uptake: A behavioural and cultural insights perspective and rapid review (2026) · cites this paper as [45]

  • In a scoping review of the role of community health workers in BC screening, direct assistance or performance of screening and navigational services were found effective.

    “In a scoping review of the role of community health workers in BC screening, direct assistance or performance of screening and navigational services were found effective [45].”

    From Improving cancer screening uptake: A behavioural and cultural insights perspective and rapid review (2026) · cites this paper as [45]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 38

  1. [2]Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018; 68: 394– 17. 30207593
  2. [4]Fitzmaurice C, Allen C, Barber RM, et al. Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 32 cancer groups, 1990 to 2015: a systematic analysis for the global burden of disease study. JAMA Oncol. 2017 4 1; 3: 524– 548. 27918777 PMC6103527
  3. [6]Coughlin SS, Ekwueme DU. Breast cancer as a global health concern. Cancer Epidemiol. 2009 11; 33: 315– 318. 19896917
  4. [7]Sharma R. Breast cancer incidence, mortality and mortality-to-incidence ratio (MIR) are associated with human development, 1990–2016: evidence from Global Burden of Disease Study 2016. Breast Cancer. 2019 7 1; 26: 428– 445. 30604398
  5. [8]Pallas SW, Minhas D, Pérez-Escamilla R, et al. Community health workers in low- and middle-income countries: what do we know about scaling up and sustainability? Am J Public Health. 2013 7; 103: e74– 82. PMC3682607 23678926
  6. [9]Daly B, Olopade OI. A perfect storm: how tumor biology, genomics, and health care delivery patterns collide to create a racial survival disparity in breast cancer and proposed interventions for change. CA Cancer J Clin. 2015 6; 65: 221– 238. 25960198
  7. [10]DeSantis CE, Ma J, Sauer AG, et al. Breast Cancer Statistics, 2017 - Racial disparity in mortality by state. CA Cancer J Clin. 2017; 67: 439– 448. 28972651
  8. [11]DeSantis CE, Ma J, Gaudet MM, et al. Breast Cancer Statistics, 2019. CA Cancer J Clin. 2019; 69: 438– 451. 31577379
  9. [12]Oluwasanu M, Olopade OI. Global disparities in breast cancer outcomes: new perspectives, widening inequities, unanswered questions. Lancet Glob Health. 2020 8; 8: e978– 9. 32710868 PMC7375795
  10. [13]Siddharth S, Sharma D. Racial disparity and triple-negative breast cancer in African-American women: a multifaceted affair between obesity, biology, and socioeconomic determinants. Cancers (Basel) [Internet]. 2018 12 14 [cited 2020 5 10]; 10: 514. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6316530/ PMC6316530 30558195
  11. [14]Perry HB, Zulliger R, Rogers MM. Community health workers in low-, middle-, and high-income countries: an overview of their history, recent evolution, and current effectiveness. Annu Rev Public Health. 2014; 35: 399– 421. 24387091
  12. [15]World Health Organization. WHO guideline on health policy and system support to optimize community health worker programmes. [Internet]. 2018 [cited 2020 4 16]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK533329/ 30431747
  13. [16]Jeet G, Thakur JS, Prinja S, et al. Community health workers for non-communicable diseases prevention and control in developing countries: evidence and implications. PLoS ONE [Internet]. 2017 7 13 [cited 2020 4 16]; 12: e0180640. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5509237/ PMC5509237 28704405
  14. [17]O’Donovan J, O’Donovan C, Nagraj S. The role of community health workers in cervical cancer screening in low-income and middle-income countries: a systematic scoping review of the literature. BMJ Glob Health. 2019; 4: e001452. PMC6528769 31179040
  15. [18]O’Donovan J, Newcomb A, MacRae MC, et al. Community health workers and early detection of breast cancer in low-income and middle-income countries: a systematic scoping review of the literature. BMJ Glob Health. 2020 5 1; 5: e002466. PMC7228495 32409331
  16. [19]Wells KJ, Luque JS, Miladinovic B, et al. Do community health worker interventions improve rates of screening mammography in the united states? A systematic review. Cancer Epidemiol Prev Biomark. 2011 8 1; 20: 1580– 1598. PMC3153589 21653645
  17. [20]Wadler BM, Judge CM, Prout M, et al., Improving breast cancer control via the use of community health workers in South Africa: a critical review [Internet]. J Oncol. 2011 [cited 2020 5 10]; 2011: e150423. Hindawi. Available from: https://www.hindawi.com/journals/jo/2011/150423/ PMC2948888 20936151
  18. [21]Arksey H, O’Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005 2 1; 8: 19– 32.
  19. [22]Olaniran A, Smith H, Unkels R, et al. Who is a community health worker? - a systematic review of definitions. Glob Health Action. 2017; 10: 1– 13. PMC5328349 28222653
  20. [25]McColl MA, Shortt S, Godwin M, et al. Models for integrating rehabilitation and primary care: a scoping study. Arch Phys Med Rehabil. 2009 9 1; 90: 1523– 1531. 19735780
  21. [26]Brandford A, Adegboyega A, Combs B, et al. Training community health workers in motivational interviewing to promote cancer screening. Health Promot Pract. 2018 3 1; 20: 1524839918761384. 29577772
  22. [27]Williams KP, Mullan PB, Todem D. Moving from theory to practice: implementing the Kin Keeper Cancer Prevention Model. Health Educ Res. 2009 4; 24: 343– 356. 18515265
  23. [28]Gutnik L, Lee C, Msosa V, et al. Clinical breast examination screening by trained laywomen in Malawi integrated with other health services. J Surg Res. 2016; 204: 61– 67. 27451869 PMC4963624
  24. [29]Hunt BR, Allgood KL, Kanoon JM, et al. Keys to the successful implementation of community-based outreach and navigation: lessons from a breast health navigation program. J Cancer Educ. 2017 3; 32: 175– 182. 26341220
  25. [30]Han H-R, Y S, M K, et al. Breast and cervical cancer screening literacy among korean american women: a community health worker-led intervention. Am J Public Health. 2017 1; 107: 159– 165. 27854539 PMC5308166
  26. [32]Chowdhury TI, Love RR, Chowdhury MTI, et al. Feasibility study of case-finding for breast cancer by community health workers in rural Bangladesh. Asian Pac J Cancer Prev APJCP. 2015; 16: 7853– 7857. 26625810
  27. [33]Ford S, Meghea C, Estes T, et al. Assessing the fidelity of the Kin KeeperSM prevention intervention in African American, Latina and Arab women. Health Educ Res. 2014 2; 29: 158– 165. 24122323 PMC3894668
  28. [34]Larkey LK, Herman PM, Roe DJ, et al. A cancer screening intervention for underserved Latina women by lay educators. J Womens Health. 2012 5; 21: 557– 566. 22416791
  29. [35]Schuster ALR, Frick KD, Huh B-Y, et al. Economic evaluation of a community health worker- led health literacy intervention to promote cancer screening among Korean American women. J Health Care Poor Underserved. 2015 5; 26: 431– 440. 25913341 PMC4756395
  30. [36]Diamond L, Izquierdo K, Canfield D, et al. Review of the impact of patient-physician non-English language concordance on quality of care and outcomes. J Gen Intern Med. 2019 8; 34: 1591– 1606. 31147980 PMC6667611
  31. [37]Street RL, O’Malley KJ, Cooper LA, et al. Understanding concordance in patient-physician relationships: personal and ethnic dimensions of shared identity. Ann Fam Med. 2008 5 1; 6: 198– 205. 18474881 PMC2384992
  32. [38]Hall M, Olopade OI. Confronting genetic testing disparities: knowledge is power. JAMA. 2005 4 13; 293: 1783– 1785. 15827320
  33. [39]Matthews AK, Cummings S, Thompson S, et al. Genetic testing of African Americans for susceptibility to inherited cancers. J Psychosoc Oncol. 2000 8 18; 18: 1– 19.
  34. [40]Gehlert S, Sohmer D, Sacks T, et al. Targeting health disparities: a model linking upstream determinants to downstream interventions. Health Affairs Project Hope. 2008 4; 27: 339– 349. 18332488 PMC2494954
  35. [41]Kohler RE, Miller AR, Gutnik L, et al. Experiences and perceptions regarding clinical breast exam screening by trained laywomen in Malawi. Cancer Causes Control. 2017 2; 28: 137– 143. 28097471 PMC5419072
  36. [42]Pace LE, Dusengimana J-MV, Keating NL, et al. Impact of breast cancer early detection training on Rwandan health workers’ knowledge and skills. J Glob Oncol. 2018; 4: 1– 10. PMC6223427 30241228
  37. [43]Tum SJ, Maree JE, Clarke M. Creating awareness and facilitating cervical and breast cancer screening uptake through the use of a Community Health Worker: a pilot intervention study. Eur J Cancer Care (Engl). 2013 1; 22: 107– 116. 22966910
  38. [44]Rajagopal PS, Olopade OI. Black lives matter worldwide: retooling precision oncology for true equity of cancer care. Cell Rep Med. 2020 8 25; 1: 100079. 32864637 PMC7446667

Cited by

Sorted by citations

Authors
Hand, T., Rosseau, N. A., Stiles, C. E., Sheih, T., Ghandakly, E., Oluwasanu, M., & Olopade, O. I.
Affiliations
  • George Washington University (US)
  • University of Chicago (US)
  • University of Ibadan (NG)
Corresponding author
Olopade, Olufunmilayo I.
ORCID
Venue
Global Health Action
Publisher
Informa UK Limited
Published
2021-01
Volume
14
Issue
1
Pages
1883336-1883336
ISSN
  • 1654-9716 (ISSN-L)
  • 1654-9880
DOI
10.1080/16549716.2021.1883336
PMC
PMC8079044
OpenAlex
W3159105343
Cited by
47
References
1
Citations by year
2026: 4 · 2025: 13 · 2024: 11 · 2023: 7 · 2022: 10 · 2021: 2
FWCI
0.91
Type
journal article
Language
en
Open access
Licence
Locations
  • Global Health Action (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
  • National Cancer Institute (1R25CA240134)
  • Scholars in Oncology Associated Research
Topics
  • Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Women's cancer prevention and management
  • Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
Keywords
community health workers, breast cancer screening, health equity, low- and middle-income countries, high-income countries, health education, screening uptake, cost analysis, vulnerable populations
MeSH terms
Bangladesh, Breast Neoplasms, Community Health Workers, Health Promotion, Humans, Malawi, Peru, Rwanda, South Africa, United States, Early Detection of Cancer

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review