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Cancer Screening: Client Reminders – Breast Cancer


What the CPSTF Found

About The Systematic Review

The CPSTF finding is based on evidence from a Community Guide systematic review published in 2008 (Baron et al., 19 studies, search period 1966-2004) combined with more recent evidence (6 studies, 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. This finding updates and replaces the 2008 CPSTF finding on Cancer Screening: Client Reminders – Breast Cancer pdf icon [PDF - 314 kB].


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Summary of Results

Detailed results from the systematic review are available in the CPSTF Finding and Rationale Statement pdf icon [PDF - 152 kB].

The 2008 review included 19 studies. This update included an additional 6 studies. Combined evidence from both the original and the updated review showed the following.

  • Mammography screening: median increase of 14.0 percentage points (interquartile interval [IQI]: 2.0 to 24.0 percentage points; 19 studies with 32 study arms).
  • Recent mammography screening: median increase of 12.3 percentage points (IQI: 3.0 to 18.9 percentage points; 30 study arms).
  • Repeat mammography screening: median increase of 6.0 percentage points (IQI 3.0 to 19.1 percentage points; 8 study arms).
  • Enhanced and telephone reminders showed a greater increase (15.5 percentage points [IQI 7.0 to 29.0 percentage points]; 20 study arms) than written reminders alone (4.5 percentage points [IQI: 1.9 to 14.0 percentage points]; 14 study arms).
  • When added to other types of interventions, the median incremental effect for client reminders was an increase of 5.0 percentage points (IQI 1.6 to 6.7 percentage points; 12 study arms).

Summary of Economic Evidence

Detailed results from the systematic review are available in the CPSTF Finding and Rationale Statement pdf icon [PDF - 152 kB].

The updated search for evidence included five studies about breast cancer (1 study) or colorectal cancer (4 studies) screening. Monetary values are presented in 2009 U.S dollars.

  • Of the included studies, one provided only cost information and four provided cost-effectiveness information.
    • One study found automated telephone reminders were the most effective strategy to increase mammography and also had the lowest average cost of $0.35/woman.
    • The cost-effectiveness studies found the cost per additional screening ranged from $7.89 to $1,149. The high end of the range was due to high personnel costs combined with a small intervention effect.


Tailored and untailored client reminder interventions to increase breast cancer screening should be applicable across a range of settings and populations, provided they are adapted and targeted for a specific population and delivery context.

Evidence Gaps

Each Community Preventive Services Task Force (CPSTF) 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 CPSTF finds insufficient evidence to determine whether an intervention strategy works, evidence gaps encourage researchers and program evaluators to conduct more effectiveness studies. When the CPSTF 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 CPSTF recommendation is based.

Identified Evidence Gaps

The following outlines evidence gaps for client reminders to increase breast, cervical, or colorectal cancer screening.

  • How do newer methods of communication (e.g., the Internet, e-mail, text messages, or automated telephone calls) influence the effectiveness of client reminder interventions?
  • To what extent does effectiveness vary for groups overdue for screening or never screened?
  • Does effectiveness vary according to the source of client reminders (e.g., clinic or practice versus screening registry or program)?
  • Do reminders for screenings for multiple cancer sites work as well as those for a single cancer site?
  • 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?
  • What are the incremental effects of adding intervention components to other interventions?
  • What is the influence of health system factors on intervention effectiveness?


Study Characteristics

Following are characteristics of included studies from the updated search period.

  • Interventions included both textual and telephone reminders (automated interactive voice response reminders by phone as well as tailored and enhanced interventions).
  • Reminders were delivered by clinical practices or organizations, screening programs or registries, or other sources.
  • Outcomes were assessed by self-report, medical record review, administrative records, or screening program attendance.
  • Where specified, interventions were conducted in the U.S. and Norway in urban or mixed urban/rural settings.
  • Studies included white, African-American, and Hispanic participants, and populations with low socioeconomic status.