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Cancer > Cancer Screening > Client Reminders
Client-oriented Cancer Screening Interventions: Client Reminders
On behalf of the Task Force on Community Preventive Services, a team of subject matter specialists and other scientists conducted a systematic review of published studies evaluating the effectiveness of client reminders in increasing screening for breast, cervical and colorectal cancer.
The Task Force recommends interventions that use client reminders based on evidence of their effectiveness in increasing:
- breast cancer screening by mammography
- cervical cancer screening by Pap test, and
- colorectal cancer screening by fecal occult blood testing (FOBT).
The Task Force concluded there was insufficient evidence to determine the effectiveness of using client reminders to increase:
- colorectal cancer screening by flexible sigmoidoscopy, colonoscopy, or double contrast barium enema.
- Client reminders are printed (letter or postcard) or telephone communications that tell people they are due (reminder) or
late (recall) for screening.
- Some client reminders only tell people that screening is due or late, while others also include:
- additional information about indications for, benefits of, and ways to overcome barriers to screening, and
- help with appointment scheduling.
Breast Cancer: Client Reminders Recommended to Increase Screening
Findings from the Systematic Review
- Sixteen studies qualified for the systematic review and evaluated 29 different interventions.
- There was a median increase of 14.0 percentage points in the proportion of study participants who received breast cancer
screening by mammography
- Printed reminders alone: median increase 3.0 percentage points (n=12).
- Printed reminders combined with additional components or with follow-up printed or telephone reminders: median increase
23.5 percentage points (n=14).
- Reviewed studies were conducted in both rural and urban communities and among different racial, ethnic, and socioeconomic groups.
Cervical Cancer: Client Reminders Recommended to Increase Screening
Findings from the Systematic Review
- Eleven studies qualified for the systematic review and included 15 outcome measures.
- There was a median increase of 10.2 percentage points in the proportion of study participants who completed cervical cancer screening by Pap test among the 14 included interventions.
- Printed reminders alone: median increase of 9.8 percentage points (n=8).
- Printed reminders combined with additional components or with follow-up printed or telephone reminders: median increase of 15.5 percentage points (n=6).
- Reviewed studies were conducted in both rural and urban communities and among different racial, ethnic, and socioeconomic groups.
Colorectal Cancer: Client Reminders Recommended to Increase Screening by FOBT
Findings from the Systematic Review
- Four studies qualified for the systematic 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.
- These finding may not apply to screening by flexible sigmoidoscopy, colonoscopy, or double contrast barium enema, because none of the qualifying studies addressed these procedures.
Prior to and during the literature review and data analysis, the review team and the Task Force on Community Preventive Services attempt to address the key questions of what interventions work, for whom, under what conditions, and at what cost. Lack of sufficient information often leaves one or more of these questions unanswered. The Community Guide refers to these as “research gaps". Research gaps are pulled together in the form of a basic set of questions to inform a research agenda for those in the field. Each completed Community Guide review includes a section on research gaps (or issues) and this is included in final evidence review publications.
Cancer is a major public health problem in the United States. For more information on the scope of this problem, visit
Background on Screening for Breast, Cervical and Colorectal Cancers.
Evidence Review:
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.
Am J Prev Med 2008;35(1S):34-55.
Recommendations:
Task Force on Community Preventive
Services. Recommendations for client- and
provider-directed interventions to increase
breast, cervical, and colorectal cancer screening
Am J Prev Med 2008;35(1S):21-5.
The findings and conclusions in this report are those of the authors and the Task Force on Community Preventive Services and do not necessarily represent the official position of the CDC.
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. Client-oriented cancer screening interventions: client reminders.
www.thecommunityguide.org/cancer/screening/client-reminders.htm.
Last Updated: MM/DD/YYYY.
Review completed: July 2008
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