Increasing Cancer Screening: Client Reminders

(2008 Archived Review)

Reminders include letters, postcards, or phone calls to alert clients that it is time for their cancer screening. Some note only that the test is due, while others include facts about the screening or offer to help set up an appointment.

Summary of Task Force Recommendations & Findings

The Community Preventive Services Task Force recommends interventions that use client reminders based on evidence of their effectiveness in increasing:

• Breast cancer screening by mammography (strong evidence)
• Cervical cancer screening by Pap test (strong evidence)
• Colorectal cancer screening by fecal occult blood testing (FOBT) (sufficient evidence)

The Task Force finds insufficient evidence to determine the effectiveness of using client reminders to increase colorectal cancer screening by flexible sigmoidoscopy, colonoscopy, or double contrast barium enema.

Task Force Finding

Results from the Systematic Review

Breast Cancer

Nineteen studies qualified for the systematic review.

• Client reminders: median increase of 14.0 percentage points in the proportion of study participants who were screened for breast cancer
• Printed reminders alone: median increase of 3.0 percentage points (12 studies or study arms)
• Printed reminders combined with other components or follow-up printed or telephone reminders: median increase of 23.5 percentage points (14 studies or study arms)

Reviewed studies were conducted in both rural and urban communities and among different racial, ethnic, and socioeconomic groups.

Economic Review

• Six studies qualified for the economic review. All monetary values are reported in 2008 US dollars. Reminder costs ranged from $4.89 to $100.61 per additional screening (six studies).
  • Reminder involving physician participation: $43.12 to $100.61
  • Reminder involving non-physician staff: $4.89 to $22.00
  • Enhanced reminder including letters and educational material: $47.01 to $63.28
• The range of estimates for these six studies make it difficult to ascertain the most cost-effective approach, although based on relatively few studies, physician participation and enhancement of reminders seem to add to the cost of the intervention.

Find a Research-tested Intervention Program (RTIP) about the use of client reminders to increase breast cancer screening (What is an RTIP?).

Cervical Cancer

Eleven studies qualified for the review and included 15 outcome measures.

• There was a median increase of 10.2 percentage points in the proportion of study participants who completed Pap tests among the 14 included interventions.
• Printed reminders alone: median increase of 9.8 percentage points (8 studies or study arms)
• Printed reminders combined with additional components or with follow-up printed or telephone reminders: median increase of 15.5 percentage points (6 studies or study arms)

Reviewed studies were conducted in both rural and urban communities and among different racial, ethnic, and socioeconomic groups.

Find a Research-tested Intervention Program (RTIP) about the use of client reminders to increase cervical cancer screening (What is an RTIP?).

Colorectal Cancer

Four studies qualified for the review and included eight outcome measures.

• There was a median increase of 11.5 percentage points in the proportion of study participants who completed colorectal cancer screening by fecal occult blood testing (FOBT).
• There were too few studies to evaluate effect size by type of reminder, either across or within studies.

None of the qualifying studies addressed flexible sigmoidoscopy, colonoscopy, or double contrast barium enema screening, so the findings may not apply to these.

Find a Research-tested Intervention Program (RTIP) about the use of client reminders to increase colorectal cancer screening (What is an RTIP?).

These findings were based on a systematic review of all available studies, conducted on behalf of the Task Force by a team of specialists in systematic review methods, and in research, practice and policy related to cancer prevention and control.

Supporting Materials

• Analytic framework [PDF - 410KB]
• Evidence Gaps
• Summary evidence table [PDF - 116KB]
• Included Studies [PDF - 29KB]
• Search Strategy

Publications

Baron RC, Rimer BK, Breslow RA, et al. Client-directed interventions to increase community demand for breast, cervical, and colorectal cancer screening: a systematic review. [PDF - 1.05MB] Am J Prev Med 2008;35(1S): S34-55.

Task Force on Community Preventive Services. Recommendations for client- and provider-directed interventions to increase breast, cervical, and colorectal cancer screening. [PDF - 74KB] Am J Prev Med 2008;35(1S): S21-5.

More Community Guide publications about Cancer Prevention and Control

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Sample Citation

The content of publications of the Guide to Community Preventive Services is in the public domain. Citation as to source, however, is appreciated. Sample citation:
Guide to Community Preventive Services. Increasing cancer screening: client reminders (2008 archived review). www.thecommunityguide.org/cancer/screening/client-oriented/reminders_archive.html. Last updated: MM/DD/YYYY.

Review completed: July 2008