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Cancer Screening: Client Reminders – Colorectal Cancer

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What the CPSTF Found

About The Systematic Review

The CPSTF finding for client reminders to increase screening for colorectal cancer by FOBT is based on evidence from a Community Guide systematic review published in 2008 (Baron et al., 4 studies, search period 1966-2004) combined with more recent evidence (3 studies, search period 2004-2008). The finding for colorectal cancer screening by colonoscopy or flexible sigmoidoscopy 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 (2 studies, search period 2004-2008).

The systematic reviews were 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. These findings update and replace the 2008 CPSTF findings on Cancer Screening: Client Reminders – Colorectal Cancer by FOBT pdf icon [PDF - 305 kB] and Cancer Screening: Client Reminders – Colorectal Cancer by Colonoscopy or Flexible Sigmoidoscopy pdf icon [PDF - 303 kB].

Summary of Results

Detailed results from the systematic review are available in the published evidence review pdf icon [PDF - 229 kB].

Results from the 2008 Review

The original colorectal cancer review included 4 studies on client reminders to increase cancer screening by FOBT.

Results from the Updated Review

The updated review included 3 additional studies on colorectal cancer screening by FOBT. Combined evidence from both the original and the updated review showed the following.

  • When added to other types of interventions, the median incremental effect for FOBT use was an increase of 10.9 percentage points (5 studies with 9 study arms)

Two studies with five study arms that evaluated client reminders to increase colorectal cancer by flexible sigmoidoscopy, colonoscopy, or barium enema showed a low estimated effect.

Summary of Economic Evidence

Detailed results from the systematic review are available in the published evidence review pdf icon [PDF - 229 kB].

The updated search for evidence included five studies about client reminders to increase screening for breast cancer (1 study) or colorectal cancer (4 studies). One study provided only cost information and four provided cost-effectiveness information.

Applicability

Tailored and untailored client reminder interventions to increase colorectal cancer screening by FOBT 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

Additional research and evaluation are needed to answer the following questions and fill existing gaps in the evidence base.

  • 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 FOBT studies from the updated search period.

  • Interventions used print reminders. None were tailored and two were enhanced.
  • Reminders were delivered by clinical practices or organizations, or screening programs.
  • Outcomes were assessed by survey and medical record review.
  • Where specified, interventions were conducted in the U.S. and Italy.
  • One study reported including nonwhite participants, although it did not provide more specific information, and two studies reported including mixed urban/rural or non-urban populations.

The two included studies that evaluated client reminders to increase screening by flexible sigmoidoscopy, colonoscopy, or barium enema provided information about incremental effects of client reminders on use of screening methods.

Publications