Open Access Research article

Advanced practice registered nurses, physician assistants and cancer prevention and screening: a systematic review

Alexandria A Smith1, Deanna Kepka234* and K Robin Yabroff2

Author Affiliations

1 American Legacy Foundation, Washington, DC, USA

2 Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA

3 College of Nursing, University of Utah, Salt Lake City, UT

4 Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT

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BMC Health Services Research 2014, 14:68  doi:10.1186/1472-6963-14-68

Published: 12 February 2014



For more than two decades, integration of team-based approaches in primary care, including physicians, advanced practice registered nurses and physician assistants (APRN/PA), have been recommended for improving healthcare delivery, yet little is known about their roles in cancer screening and prevention. This study aims to review the current literature on the participation and roles of APRN/PAs in providing cancer screening and prevention recommendations in primary care settings in the United States.


We searched MEDLINE and CINAHL to identify studies published in 1990–2011 reporting on cervical, breast, and colorectal cancer screening and smoking cessation, diet, and physical activity recommendations by APRN/PAs in the United States. A total of 15 studies met all of our eligibility criteria. Key study, provider, and patient characteristics were abstracted as were findings about APRN/PA recommendations for screening and prevention.


Most studies were cross-sectional, showed results from within a single city or state, had relatively small sample sizes, reported non-standardized outcome measures. Few studies reported any patient characteristics. APRN/PAs are involved in recommending cancer screening and prevention, although we found variation across screening tests and health behavior recommendations.


Additional research on the cancer prevention and screening practices of APRN/PAs in primary care settings using standardized outcome measures in relation to evidence-based guidelines may help strengthen primary care delivery in the United States.