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Cancer Screening: Client Reminders – Cervical Cancer

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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., 11 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 – Cervical Cancer pdf icon [PDF 309 kB].

Context

There is no information for this section.

Summary of Results

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

Results from the 2008 Review

The original cervical cancer screening review included 11 studies.

  • Pap test: median increase of 10.2 percentage points (interquartile interval [IQI]: 6.3 to 17.9 percentage points; 14 study arms).
  • Enhanced and telephone reminders showed greater increase (15.5 percentage points; 6 study arms) than written reminders alone (9.8 percentage points; 8 study arms).

Results from the Updated Review

The updated review included 6 additional studies.

  • Pap test: median increase in use was 2.8 percentage points (range 1.6 to 31.4; 4 studies).
  • Enhanced and telephone reminders showed an increase of 1.6 to 31.4 percentage points (3 studies; 4 study arms).
  • The incremental effect client reminders added to provider-directed interventions was a median increase of 3.7 percentage points (range –3.5 to 25.2; 5 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.

Applicability

Tailored and untailored client reminder interventions to increase cervical 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 print reminders only (3 studies), telephone reminders only (1 study), and print reminders with telephone follow-up (2 studies).
  • Reminders were delivered by clinical practices or organizations, or screening programs or registries.
  • Outcomes were assessed by medical record review, administrative records, or screening registry records.
  • Where specified, interventions were conducted in the U.S., Sweden, Belgium, and Australia.
  • One study reported including nonwhite participants but did not provide more specific information, one study specified a population with low socioeconomic status, and three studies reported including urban or mixed urban/rural populations.

Publications