Introduction

Screening for cancer and precancerous lesions can improve the chance of recovery and slow progression of the disease if detected early [1,2,3]. Cancer screeninghoweveris not without side effectsand thereforeroutine cancer screening tests with the lowest harm and highest benefits are recommended for specific age groups and time intervals [24] (Appendix A). Despite the recommendations and programs in placescreening coverage varies widelyand even high-income countries struggle to increase and maintain screening coverage. In the United States (U.S.)median screening rates in 2020 for mammography and colorectal cancer were 71% (eligible ages: 50 to 74 years) and 59% (eligible ages: 45 to 75 years)respectively [5]. In England68.7% took up breast cancer screening (eligible ages: 50 to 71 years)and 65.9% (eligible ages: 60 to 74 years) were adequately screened for colorectal cancer between 2019 and 2020 [6].

Even though the prevalence of most cancers is higher in older populationsit can occur at any age [7]. A noticeable shift in cancer incidence is seen as cancer becomes more common in younger generations [8]. In 2020new cancer cases for all cancers in the working-age population (15–69 years) were 11 millionmore than half of the total diagnoses worldwide [8]. The United States Preventive Services Task Force (USPSTF) reported that from 2000–2 to 2014–16a rise of ~ 15% was recorded in colorectal cancer incidence in people aged 40–49 years [9].

Along with this trendthe burden of cancer on the working population becomes more extensiveimpacting every aspect of their lives [10]. Cancer can heavily impact work ability [11,12,13,14,15]financial stability [10]and productivity [11,12,13,14,15]resulting in difficulty securing and maintaining employment for cancer patients or those recovering [1617]. Furtherthose returning to work may endure additional challengessuch as discriminationbiasor even layoffs if they are considered incapable of performing their jobs effectively [18]. It is evident that the burden of cancer extends beyond the individualto their familiesemployers and society as a whole [16].

Workplacesas a settingcan affect change in public health and in individual behaviours [19]and can be used to strengthen cancer screening engagement [2021]. Workplaces can provide easy and regular access to people from various sociodemographic and economic positions [20] and influence screening behaviour [22] by providing positive social normsa convenient setting for screeningremoving structural barriers for employees and promoting health education [1923]. Workplace incentives can also motivate employees to take up screening services [21]. Employers on their sidehave motives to implement interventions targeting employee wellbeingas they have a responsibility to protect and prioritise the health of their employees by implementing health and safety regulations and by promoting healthy behaviours [24]. For working environments that are considered to be exposing their employees to known cancer risksincluding carcinogenssedentary lifespsychological distressand shift workemployers and organizations may be considered partially responsible for providing cancer screening [25].

To our knowledgeworkplace cancer screening intervention studies to date have only examined single workplacesor single or two cancers at a time. Thereforethis study aims to undertake a systematic review to assess the effectiveness of workplace cancer screening promotion and cancer screening uptake interventionsas well as the factors that can facilitate or hinder engagementuptake and the effectiveness of these interventions.

Methodology

The protocol for this review was registered in PROSPERO (CRD42022334827).

Research Questions:

1. Are workplace cancer screening promotion interventions and cancer screening uptake interventions effective?

2. What are the factors that influence engagementuptake and the effectiveness of these interventions?

Workplace cancer screening promotion and screening uptake interventions

We focus on cancer screening promotion and screening uptake interventions for four common types of cancer with recommended screening tests by the USPSTF: breastlungcolorectumand cervix uteri [926,27,28]. Prostate cancer screeningalthough the prevalence is highwas not included as this is not recommended for population-based screening [29]. During the literature reviewwe considered the screening recommendations by reputable organizations including the World Health Organizationthe United States Preventive Services Task Force (USPSTF)the National Health Service of the United Kingdom and the American Cancer Society. In the endwe chose to use the USPSTF recommendations as the base guideline since it has the broadest and most clear range of recommended ages and screening investigationswith regular updates. Workplace cancer screening promotion interventions were defined as interventions promoting knowledge and information on existing cancer screening serviceswithout offering physical screening tests by workplaces or researchers. This may promote the use of existing national screening programs or individual out-of-pocket screening uptake. Examples of cancer screening promotion interventions are health talks on breast cancer screening at workplaces and allowed paid time off to attend screening. Cancer screening promotion interventions were included in the review as some workplaces may only be able to promote cancer screening because firstlythe availability of cancer screening services varies depending on each country’s health system (e.g. in the UKNational Health Service (NHS) screening services are available to all eligible citizens)[30]and secondlyassociated costs may render screening tests prohibitive for workplaces.

Workplace cancer screening uptake interventions were defined as interventions in which employees were offered cancer screening services by workplaces or by researchers in workplaces as another screening opportunity additional to the national programs or individual screening in the private sector (e.g.providing cervical cancer self-screening test kits to the employees at work). The workplace interventions included could be organised by the employer or by an external agency but supported by the workplace.

Search strategy

The search strategy was generated by combining three core concepts: (i) workplace settings and/or interventions organised by workplaces; (ii) cancer; and (iii) the four sites of common cancers and screening tests. Search terms were developed for each conceptusing truncationsBoolean and proximity operatorsand Medical Subject Headings (MeSH). Pilot searches were conducted to balance a good level of sensitivity and specificity in identifying relevant articles. The search was performed in six databases: Embase (Ovid)Medline (Ovid)Web of ScienceCumulative Index to Nursing and Allied Health Literature (Table 1 and Appendix B).

Table 1 Search strategy consulted in Embase (Ovid)
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Inclusion and exclusion criteria

Papers were included if they: (i) presented on cancer screening promotion and screening uptake interventions delivered in workplaces and/or organised by workplaces; (ii) presented on interventions performed on working adults; (iii) were published between 2010 and the date of search (8th April 2024); and (iv) were written in English. In addition(vi) interventions had to focus on at least one of the four types of cancer: breastlungcolorectaland cervical cancersand (vii) the screening tests promoted or offered had to be recommended by the USPSTF [4]. The search was not restricted to geographical regions or study designs to obtain an inclusive overview of interventions. Studies did not have to specifically examine occupational cancers e.g. due to exposure to known carcinogens nor did the intervention have to only be in place to adhere to regulatory compliance.

Papers were excluded if they: (i) studied interventions in settings other than workplaces or that were not organised or supported by workplaces; (ii) were not on humans and not on working adults; (iii) were not published within the timeline of 2010 to the date of search (8th April 2024); (iv) were not written in English; (v) were not peer-reviewed studiesand were conference abstracts or grey literature; (vi) measured outcomes other than the targeted ones or interventions on any other cancer types; and (vii) were promoting or offering screening tests not recommended by the USPSTF (Appendix A).

The process of identifying articles

The selection process was carried out by two independent reviewerswith the first reviewer reviewing 100% of the articles and the second reviewer screening 10% of the articles. Disagreements were resolved by discussion and all final full texts were agreed by two reviewers. The web application “Rayyan” was used to deduplicatescreen titleabstract and full textas well as to record the codes and reasons for exclusion [31].

Quality and risk of bias assessment

Quality assessment and risk of bias assessment was conducted by the first reviewer and a second reviewer assessed 10% of the studies. Quality assessment was done using the Consolidated Standards of Reporting Trials: 2010 statement (CONSORT) for randomised controlled trials and the Transparent Reporting of Evaluations with Nonrandomized Design (TREND) for non-randomised controlled trials [3233]. Individual items were rated as 10.5and 0 for each item. Scores were added and papers were rated high quality if the score was ≥ 80% of the maximum possible scoremoderate quality for scores between 60 – 79% and low quality for scores < 60% [3435].

The revised version of the Cochrane Risk of Bias tool (ROB 2) was employed to assess randomised controlled trial (RCTs) and the Risk Of Bias In Non-randomised Studies—of Interventions (ROBINS-I) for non-randomised studies [3637]. “The Critical Appraisal Skills Programme (CASP) tool for Evaluating Qualitative Research” was used for appraising risk of bias for qualitative Studies [38]. Disagreements between the reviewers were resolved by discussion.

Data extraction and data analysis

Data extraction included: (i) study characteristics; (ii) participant demographics; (iii) characteristics of workplace intervention; (iv) outcomes (change in knowledge or screening rate and factors impacting the effectiveness of interventions); and (v) other discussions and recommendations.

Our primary outcome of interest was intervention effectiveness. This was translated as effectiveness of the interventions in increasing knowledge or increasing subsequent screening rates for cancer screening promotion interventions and increasing screening uptake rates for workplace cancer screening uptake interventions. A meta-analysis could not be carried out due to the heterogeneity in types of interventionpopulations addressedstudy designs and outcome measures. Thereforea narrative analysis and evidence synthesis was done using effect direction plots to assess intervention effectiveness [39]. Effectiveness of cancer screening promotion interventions was assessed by either a statistically significant change in knowledge pre/post intervention or between intervention and control groups after interventions. For the cancer screening uptake interventionseffectiveness is assessed by statistically significant changes in the screening rates/percentage taking up screening pre/post intervention or between intervention and control groups after interventions. In the plotan upward arrow “▲” represents a positive impacta downward arrow “▼” shows negative impactand sideways arrows “◄►” denote no change/mixed effects/conflicting findings. In addition to intervention effectivenessthe magnitude of effectiveness was also estimated [34]. This was calculated by (a) comparing intervention and control groups (result of study group minus result of control group) for two-group interventions(b) comparing before and after tests (screening utilization after intervention minus screening utilization before intervention) for one-group pre-test post-test interventionsand (c) using the absolute number of screening uptake for one-group post-test only interventions. Specific cut-off points delineating an effective magnitude or minimum levels of change in screening rates that lead to clinically significant differences have not been reported [203540]. Thereforefor this studythe magnitude of effectiveness was categorized using a large arrow “▲” if the change in rate of cancer screening tests or improvement in knowledge of cancer was above 30%medium arrow “▲” if the above changes were between 5–30%and small arrow “▲” if the changes were less than 5%. GraphPad (https://www.graphpad.com/quickcalcs/binomial1/) was used to calculate the Sign test (two-tailed p-value) for each outcome domain by calculating the number of interventions with positive and negative effect directions (p-value = 0.5). Factors positively or negatively influencing workplace screening promotion and cancer screening uptake interventions that were reported in the original studieseither from the regression modelsintervention evaluations or qualitative responseswere extracted as secondary outcomes.

Results

Figure 1 presents the flow diagram of study selection. A total of 13,426 articles were identified through two searches covering the period from 2010 to 8th April 2024. 7479 articles were screened for title and abstractand 58 articles were screened for full texts. This resulted in 27 articles taken forward for quality and risk of bias assessment.

Fig. 1
Fig. 1The alternative text for this image may have been generated using AI.
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Flow diagram of the selection process of included studies

Quality assessment and risk of bias assessment

After quality and risk of bias assessmentssix articles were excluded for low quality or serious risk of bias (Appendices CD and K). Four articles promoted and offered screening tests that are not recommended by the USPSTF [26] (i.e. breast self-examination (BSE) and clinical breast examination (CBE)) and were therefore excluded from our review. Finally21 articles were included for analysis.

Overallamong the twenty-one included articleseight articles were of high quality [41,42,43,44,45,46,47,48] and thirteen of moderate quality [49,50,51,52,53,54,55,56,57,58,59] (Table 2 and Appendix C). Fourteen articles had low risk of bias [424345,46,47,48,4951525557586061]and seven studies had moderate risk of bias [41445053545659] (Table 2Appendix D.1 and D.2).

Table 2 Characteristics of Included Studies and Interventions
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Characteristics of studies

Among the twenty-one articles included and analysedtwelve papers addressed intervention effectiveness [41,42,4347505253565759,60,61]one article addressed facilitators and barriers for workplace cancer screening interventions [41,42,4347505253565759]and eight articles addressed both [48]. Five studies examined breast cancersix colorectal cancerfour cervical cancerand one article examined breast and cervical cancers. The remaining four articles discussed all three types (Table 2). There was no study examining workplace lung cancer screening that met the inclusion criteria.

Five studies were randomized controlled trials [42495758]fifteen were non-randomized trials [4143,44,45,46,4750,51,52,53,54,55,565961]and one study used a mixed-method (non-randomized trial and qualitative methods) approach [48]. Eleven articles were from the U.S. (n = 11) [4143,44,45,46,474952,53,54]and one article each was identified from Japan [60]Turkey [56]Iran [57]Ghana [48]Cambodia [59]Qatar [58]Argentina [55]Singapore [51]China [50] and Malaysia [42].

Demographic characteristics of participants

The review covered more than 6 million participants (one article did not mention number of participants) [55] (Appendix F). Participants’ age ranged from 18 to 70 + years (Appendix F). In six studiesthe sample population consisted of employees and their dependents [414446475355]. Both males and females were invited to colorectal cancer programs while only females were invited to the breast and cervical cancer interventions (except one health education program for health professionals) [51] (Appendix F). Female participant predominance was observed in five interventionsranging from 56.8% to 71.8% of the study sample [4447495455].

Characteristics of interventions

Out of the twenty-one included articlesten articles implemented cancer screening promotion interventions [42434550,51,5256,57,58] while fifteen articles offered cancer screening uptake interventions [4144,45,46,47,48,49,5052,53,54,55,5659] (Table 2). The interventions were implemented and delivered across a diverse range of workplaces without any clear patterns emergingincluding schoolsnail salons and manufacturing sites (Table 2). One exception was the healthcare related sector that featured in 5 of the 19 studies [4448495154].

For all cancer typesin addition to covering the costs of screening servicessome interventions offered financial incentives to participants (e.g.cash [414345] or gift cards [46]) (Table 2). Two interventions used gift draws to increase participation [5354]while another provided incentives in the form of rewards tied to activity completion such as health savingsreimbursementor incentive accounts [44]. Other types of incentives were bonusespremium reductionspaid time off work [4144]and small gifts (e.g. T-shirtshatspensdrinkssnackshousehold gifts) [4853].

In the articles that specified the intervention providersspecialists such as physicianssurgeonsgynaecologistsand nurses were involved in offering educational seminarshealth talks and cancer screening servicesin addition to the researchers and responsible persons from the workplace [48515459]. Furthermorecooperation with lay health workers (trained health workers without formal professional or paraprofessional certificates [62])health educators and primary health workers was documented [434558]. Peer champions (‘peer colon cancer champions’) were used in one workplace; these were volunteers from within the workplace interested in colon cancer often due to personal experience or experience among family and friends [52]. The locations where the interventions took place were either physically in the workplace and/or at clinicsas some workplaces refer or support with navigation to the national cancer screening programmes. A number of interventions were online and implementation was also supported by mailing letters and test kits directly to employees' residences (Table 2) [45,46,47]. One study examined the effectiveness of allowed paid time off work (paid-sick-leave mandates) in colorectal and breast cancer screening after mandates have been active in some states of the United States [61].

With regard to the type of screening testsmammography [434558] was promoted and used for screening of breast cancer. For colorectal cancerstool DNA test (mt-sDNA) [47]faecal immunochemical tests (FIT/iFOBT) [45,46,47]and colonoscopy [61] were utilised. HPV test (self-sampling) [4350565763]HPV test (clinician sampling) [47] and Pap smear test [4553,54,55] were used for cervical cancer. The type of screening tests used was not specified in four articles [49].

Outcomes

Overalltwenty articles addressed the research question 1 on the effectiveness of workplace interventions (Appendix E). Of thesenine articles included outcomes for changes in knowledge level for breast cancer (n = 6)colorectal cancer (n = 2)and cervical cancer (n = 4)and fifteen articles assessed the screening rate for breast cancer (n = 8)colorectal cancer (n = 11)and cervical cancer (n = 5). In additionnine articles addressed our second research question (i.e. the faciliators and barriers affecting intervention implementationdelivery and effectiveness); three articles included factors influencing the impact of cancer screening promotion interventions for breast cancer (n = 2) and cervical cancer (n = 1)and seven articles included factors influencing cancer screening for breast cancer (n = 2)colorectal cancer (n = 7)and cervical cancer (n = 2) (Appendix E).

Effect direction and magnitude of effectiveness of workplace cancer screening promotion interventions

The workplace cancer screening promotion interventions showed positive impact in all interventions of breastcolorectal and cervical cancer. A number of screening promotion interventions assessed changes in knowledge as well as subsequent changes in screening rate as well (even though the promotion intervention did not offer screening per se)as shown in details in Table 3. The primary study outcomes and original results are available for reference in Appendix I.

Table 3 Effect direction plot and magnitude of effectiveness of workplace cancer screening promotion interventions
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As shown in Table 3the magnitude of effectiveness for breast cancer screening promotion interventions displayed a 5- 30% increase in knowledge or screening rate in two interventions [4556]while four interventions had a greater than 30% increase in knowledge or screening rate on cancercancer screening or both [43505157]. The intervention by Callison et al. predicted a smaller increase with < 5% in screening rate [61].

For colorectal cancer interventionsthe study by Rafie et al. showed > 30% increase in knowledge [52]. One intervention displayed a 5- 30% increase in knowledge or screening rate [4552]while the final intervention showed < 5% increase in screening rate [61].

For cervical cancerthree out of four interventions had a great than 30% increase in knowledge or screening rate by workplace interventions [434558]while one intervention showed 5–30% increase in screening rate [42]. The magnitude (%) changei.e. increase in knowledge or screening rate for workplace cancer screening knowledge interventionsdetailed by study and cancer type can be seen in details in Table 3.

Effect direction and magnitude of effectiveness of workplace cancer screening uptake interventions

For workplace cancer screening uptake interventionsa positive effect direction was observed for the majority (18/22)while 4 interventions showed no change or mixed effects.

Among breast cancer screening uptake interventionssix interventions showed positive direction (i.e. increase in rate) while one intervention showed mixed results [44]as presented in Table 4. The primary outcomes and original study results are detailed in Appendix J. Out of the six interventions with positive impactsthree interventions had increase in cancer screening rates of > 30% [465056]one had > 30% difference between intervention and control groups [60]one had an increase rate of 5–30% [41]and the final intervention showed an increased rate of < 5% [45].

Table 4 Effect direction plot and magnitude of effectiveness of workplace cancer screening uptake interventions
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For colorectal cancernine out of ten interventions experienced increases in screeningand one intervention had mixed results [44]. Among these nine interventionsfive interventions had > 30% increase in cancer screening rate [45,46,475355]two had 5–30% increase [4152]one had 5–30% difference between study groupsand one had < 5% [54].

For cervical cancer screening uptake interventionsthree out of five interventions had positive impacts and two interventions had mixed results. Among the interventions with positive impactsone intervention had a > 30% [46] increase in cancer screening rateone had 5–30% [59]while the final intervention with a positive impact had a < 5% increase in screening rate [45]. Magnitude (%) of increase in screening can be seen in details in Table 4.

Factors positively influencing workplace screening promotion and cancer screening uptake interventions

A study by Warner et al. found that having health insurance was shown to be associated with improving cancer screening knowledge in breast cancer screening promotion interventions [45] (Appendix G). No factors influencing workplace cancer screening promotion interventions for colorectal and cervical cancer were explored in the included studies.

One factor positively influencing workplace screening uptake interventions reported by the authors of the included studies was living in suburban/urban areas [46]. Gender showed mixed results. In one intervention for colorectal cancerbeing male had higher uptake of colorectal cancer screening compared with femaleswhereas another intervention showed the opposite result with females (particularly aged 50–59 years) having higher uptake than males [4555] (Appendix G). Specifically for healthcare personnelprior use of the healthcare systeminterest in health (e.g. having attended previous seminarsgreater time spent on the digital health company’s platform and good elaboration on using colorectal cancer screening)and access to primary carewere commonly associated with increased cancer screening rate [44495154] (Appendix G).

Factors negatively influencing the workplace cancer screening promotion and screening uptake interventions

Factor that negative influence workplace colorectal cancer screening uptake interventions included increased cancer information overload (“a disposition that may be cultivated by communicating cancer information too frequently or in a way that hinders effective processing”) which related to lower uptake of FOBT and colonoscopy [49] (Appendix H). Furthermoremost common barriers to cervical cancer screening uptake included fear of cancer and embarrassment of the procedures during screening tests [58]. Barriers to workplace interventions on breast cancer were not explored in any of the included articles.

Discussion

This systematic review assessed the effectiveness of workplace cancer screening promotion interventionsincluding educational sessionsdistribution of educational materialsreminder phone callsnavigation to screening services and free time to attend screeningas well as cancer screening uptake interventions that included free screening servicesdistribution of screening test kits and financial coverage of screening services for the four most common types of cancer. Overallfor both type of interventions for breastcolorectal and cervical cancerspositive impacts were observed on the effect direction plots. For magnitude of effectiveness in both cancer screening promotion and screening uptake interventionsa more than 30% increase in knowledge or cancer screening rate was observed for most breast cancer interventions while the range varied for colorectal and cervical cancer interventions. No studies examining workplace interventions for lung cancer were includedpossibly due to its recommendation as a screening programme being directed to high-risk populations. Of notethere were no workplace interventions based in Europe identified in this review.

Results in the context of previous studies

The cancer screening rates of breast cancer screening uptake interventions in this review differed from an older review of worksite breast cancer screening programs. Caplan et al. (1998) concluded that screening rates increased between 26 to 49% among participants [64]. Howeverthe range of screening found in the current review was broaderranging from 2.1% to 64.4%. The possible reason for this difference may be due to baseline screening rates observed in the included articles in our review. For instancein the article by Warner et al.the baseline screening rate of breast cancer was already high at 66.4%and only experienced an increase of 2.1% after the workplace educational sessions [45].

This current review also found that workplace cancer screening uptake interventions could effectively improve colorectal cancer screening. Similarlya study of colorectal cancer screening in firefighters organised by the San Francisco Firefighters Cancer Prevention Foundation (SFFCPF) and not by the workplaceconcluded that interventions in workplaces could increase the use of screening services (33% increase in FIT usage) [65].

The current review saw low magnitude of effectiveness for cervical cancer screening in four out of five interventions. A similar previous studyimplemented in 2009offering cervical cancer screening through an organised screening program showed that more than half of the participants took the Pap test at least once during the follow-up [66]. This rate is higher than the interventions in our review with the same context.

Strength and limitations

A strength of this review is that there were no geographical restrictionsproviding a global perspective. Furthermoreby not limiting to one type of cancerthis review was able to offer common components and delivery methods employed in workplace interventions addressing cancer screening. Howeversome limitations should also be noted. The first limitation of this review relates to potential publication biasas studies with negative or insignificant results are less likely to be published [67]. Secondlythere is a possibility of missing articles. Despite a robust search strategythis study included published articles in Englishand thus has the possibility of missing other relevant articles written in other languages and grey literature sources. A single reviewer undertook most of the screeningbut we did have robust measures in place to mitigate any issues (e.g. all papers that were not clearly excluded were discussed between two authors and all final full texts checked by two authors). Another limitation is the lack of comparison of the effect size across interventionsas a meta-analysis was not performed due to the heterogeneity of included studies. Lastlywhile incorporating diverse geographical regions and various types of worksites is a strengthit is acknowledged that the effectivenessfacilitators and barriersmay differ due to the working environment and cultural context.

Implications

Workplace cancer screening interventions can benefit both employees and employers [68,69,70]. Furthermorethe benefits of screening for common cancers in workplaces can extend to primary and secondary care services as these interventions can lead to early cancer diagnosis. For exampleif a 5% increase in colorectal screening rate (60,000 employees) can be achieved in a workplace with over one million employeesthen there is a good chance of catching more than 1,000 FOBT-positive tests for colorectal cancer [4471]. Similarlyrises in screening uptakes in small and medium-sized workplaces will also collectively increase the possibility of diagnosing cancer cases. This again can lead to reducing health care costs and the workload of already-stretched healthcare services [72].

To implement successful interventionsworkplaces are suggested to undergo pilot testsadapt the educational sessions and screening services according to pre-test surveysprovide multiple education and service-providing sessionsand take into consideration individual preferences for screening (e.g. self-sampling of cervical cancer tests) [44465155]. Moreoverworkplaces are suggested to promote cancer screening by allowing employees to attend cancer screening during working time [73].

Care must be taken to ensure that inequalities in cancer screening are addressed but also that they are not exacerbated (e.g.between employed and unemployed populationsbut also between employees). Workplaces need to ensure that screening interventions are available to all employees and barriers to specific employee groups are minimised. Researchersthe health service and workplaces should cooperate to offer health programs to hard-to-reach professions and blue-collar workers to prevent exacerbating inequalities [7475]. To minimise inequality between employed and unemployed populationsemployers can extend their interventions to employees’ families and dependents wherever possible [76].

This review found that barriers to participating in workplace cancer screening promotion programs and utilising cancer screening services were less explored. Thereforeresearchers and worksites should find novel ways to discover these factors as they are vital in improving the efficacy of workplace interventions. Additionallyutilizing cervical cancer screening services in workplace interventions showed a low magnitude of effectiveness. Future research should explore the reasons behind this in order to effectively improve screening uptake. In additionworkplaces should ensure that screening services are offered and tested with informed choice on possible results and potential harms.

Furthermorelongitudinal studies with larger samples and studies with long-term follow-up should be carried out to explore the effectiveness of these interventions and the potential impact these interventions may havenot only on screening uptake but on detectiontreatment optionsand ultimately survival ratesas well as on non-cancer outcomes including employment and mental health. Rigorous evaluations of the interventions are also necessary to identify the impact on cancer screening uptake and how workplace screening could be linked to any organised screening programmes to avoid duplication.

Conclusion

Cancer is one of the leading causes of death globally [77]and its rising number of new cases every year has been alarmingcalling for urgent action on prevention and early detection of the disease. This systematic review presents a comprehensive overview examining the effectiveness and factors influencing workplace interventions in promoting screening and increasing cancer screening uptake in employees.

Our findings suggest that workplace interventions can have a positive impact in promoting cancer screeningincreasing knowledge around screening and on cancer screening rates that may results in the earlier detection of breastcolorectal and cervical cancers in working age adults. Our findings also suggest that workplaces and employers can design evidence-basedstructured and effective interventions by working side by side with researcherspublic health specialists and health care systems [505578]. Within the workplacehuman and material resources would need to be allocated to make such interventions sustainable and involvement should be shown all stakeholders to create workplaces that promote health [52]. Our findings also conveyed that factors that may impede participation in workplace programs should be examined in further research as very few studies have focused on these.

In the past 3 yearswhile cancer cases were expected to be risingpublic and healthcare personnel’s attentions were focused on the Covid-19 pandemic by redirecting material and human resources to the pandemic and restricting non-urgent healthcare services. Now more than everit is imperative to take action to combat the global burden of cancer. Evidence-informedrigorous approaches and novel settings such as workplaces can be used to tackle the burden of cancer and improve health not only for employees but for the wider public as well.