Decision support tools with risk-based guidance for cancer screening and early detection among the general population: A systematic review — The Association Specialists
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  3. Decision support tools with risk-based guidance for cancer screening and early detection among the general population: A systematic review

Decision support tools with risk-based guidance for cancer screening and early detection among the general population: A systematic review (23841)

Philip Ly 1 2 , Kirsten Emmert 3 , Rehana A Abdus Salam 1 4 , Sibel Saya 5 6 , Fiona White 1 , Alan White 1 , Hamzeh M Mesrian Tanha 1 , Wilfred Knight 2 , Anthony E Yeo 2 , Benjamin Schuez 3 , Anne E Cust 1 4 , Ilona Juraskova 7 , Amelia K Smit 1 4 , Julia Steinberg 1
  1. The Daffodil Centre, The University of Sydney, and Cancer Council NSW, Sydney, Australia
  2. Sydney School of Public Health, The University of Sydney, Sydney, Australia
  3. Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany
  4. Melanoma Institute Australia, The University of Sydney, Sydney, Australia
  5. Department of General Practice and Primary Care, Melbourne Medical School, University of Melbourne, Melbourne, Australia
  6. Collaborative Centre for Cancer Genomic Medicine, University of Melbourne, Melbourne, Australia
  7. School of Psychology, The University of Sydney, Sydney, Australia

 

Background

Population-based cancer screening has traditionally adopted a one-size-fits-all model, but interest is growing in risk-based approaches that tailor screening recommendations to an individual’s cancer risk. Decision support tools (DSTs) may help facilitate informed decision-making for risk-based screening and early detection. This review aimed to systematically identify, synthesise, and assess evidence from evaluations of DSTs with risk-based guidance for cancer screening, for four major cancers (breast, prostate, colorectal, melanoma).

Methods

MEDLINE and Embase databases were searched for studies published from 1 January 2013 to 20 January 2026. Studies that evaluated DSTs providing risk-based screening guidance for the general population were eligible. Studies limited to groups at high risk of cancer were excluded, as were protocols or conference abstracts. Study characteristics and DST features were extracted in duplicate. Risk-of-bias was assessed using the Joanna Briggs Institute critical appraisal tools. Findings were narratively synthesised.

Results

Twenty-one articles representing 18 studies and 15 unique DSTs were included. All tools addressed breast and/or colorectal cancer screening; most were patient-facing, web-based, and incorporated validated risk models. DSTs consistently improved knowledge and patient-provider communication, and were acceptable to users. Evidence for effects on risk-appropriate screening participation and intentions was mixed, while impacts on decisional conflict, values clarity, and anxiety were minimal or null. All studies were from high-income countries, with limited consideration of health literacy and equity.

Conclusion

DSTs incorporating risk-based guidance show promise for supporting informed breast and colorectal cancer screening decisions. However, evidence remains limited, with major gaps for other common cancers. Future research should address equity, usability, and integration into diverse healthcare settings.