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Cancer Screening: Client Incentives – Breast Cancer


What the Task Force Found

About The Systematic Review

The Task Force 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 Task Force by a team of specialists in systematic review methods, and in research, practice, and policy related to cancer prevention and control. This finding updates and replaces the 2008 Task Force finding on Cancer Screening: Client Incentives – Breast Cancer [PDF - 200 kB].


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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 the Task Force did not have enough information to determine if the intervention works.


Applicability of this intervention across different settings and populations was not assessed because the Task Force did not have enough information to determine if the intervention works.

Evidence Gaps

Each Community Preventive Services Task Force (Task Force) review identifies critical evidence gaps—areas where information is lacking. Evidence gaps can exist whether or not a recommendation is made. In cases when the Task Force finds insufficient evidence to determine whether an intervention strategy works, evidence gaps encourage researchers and program evaluators to conduct more effectiveness studies. When the Task Force recommends an intervention, evidence gaps highlight missing information that would help users determine if the intervention could meet their particular needs. For example, evidence may be needed to determine where the intervention will work, with which populations, how much it will cost to implement, whether it will provide adequate return on investment, or how users should structure or deliver the intervention to ensure effectiveness. Finally, evidence may be missing for outcomes different from those on which the Task Force recommendation is based.

Identified 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?


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):S34–S55.

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.