Cancer Screening: Client Incentives — Breast Cancer
Findings and Recommendations
The Community Preventive Services Task Force (CPSTF) finds insufficient evidence to determine the effectiveness of using client incentives to increase screening for breast cancers because only one study qualified for review.
The full CPSTF Finding and Rationale Statement and supporting documents for Increasing Cancer Screening: Client Incentives [for Breast, Cervical, and Colorectal Cancers] are available in The Community Guide Collection on CDC Stacks.
Intervention
Client incentives are small, non-coercive rewards (e.g., cash or coupons) that aim to motivate people to seek cancer screening for themselves or to encourage others (e.g., family members, close friends) to seek screening. Incentives are distinct from interventions designed to improve access to services (e.g., transportation, child care, reducing client out-of-pocket costs).
About The Systematic Review
The CPSTF finding is based on evidence from a Community Guide systematic review published in 2008 (Baron et al., 0 studies, search period 1966-2004) combined with more recent evidence (1 study, search period 2004-2008). The systematic review was conducted on behalf of the CPSTF by a team of specialists in systematic review methods, and in research, practice, and policy related to cancer prevention and control.
Study Characteristics
- The study evaluated the effect of a $10 incentive for women who completed mammography screening through a preexisting program that provided free mammograms to low-income, under-, or uninsured women.
- The intervention was sent to all women in a commercial database who were aged 40–63 years and from census blocks having household size and income characteristics consistent with program guidelines.
- Only program-eligible women were included in assessing mammography completion.
Summary of Results
No studies of breast cancer screening were identified during the previous review. One study that targeted low-income, or under or uninsured women was included in the update.
- When added to other types of interventions, the incremental effect of client incentives on screening rates was a 0.52 percentage point increase (95% confidence interval 0.32, 0.72).
Summary of Economic Evidence
An economic review of this intervention was not conducted because CPSTF did not have enough information to determine if the intervention works.
Applicability
Applicability of this intervention across different settings and populations was not assessed because CPSTF did not have enough information to determine if the intervention works.
Evidence Gaps
The following outlines evidence gaps for client incentives to increase breast, cervical, or colorectal cancer screening.
- As in the original review (Baron et al., 2008), does effectiveness vary with type of incentive?
- Is screening use sustained after discontinuation of incentives? Is length of effect related to size or perceived value of incentives? Is there a value floor or ceiling?
- Is there a threshold beyond which client incentives are effective? If so, is the magnitude of the incentive ethical or coercive?
- Are there specific populations for whom client incentives are valuable? A clearer understanding of the nature of attractive incentives for different populations would be helpful. Are one-size-fits-all incentives no longer appropriate?
- What are the incremental effects of adding intervention components to other interventions?
- What influence do newer methods of communication (e.g., the Internet, e-mail, social media, automated interactive voice response, texting) have on intervention effectiveness?
- What is the influence of health system factors on intervention effectiveness?
- Are interventions effective for promoting colorectal cancer screening with methods other than FOBT?
- Are interventions to promote colorectal cancer screening equally effective when addressing colorectal cancer screening more generally, as when specific to one type of test?
Implementation Considerations and Resources
CPSTF did not have enough evidence to determine whether the intervention is or is not effective. This does not mean that the intervention does not work, but rather that additional research is needed to determine whether or not the intervention is effective.