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Cancer Screening: Provider Incentives – Cervical Cancer


What the CPSTF Found

About The Systematic Review

The Task Force finding is based on evidence from a Community Guide systematic review published in 2008 (Sabatino, et al., search period through September 2004) combined with more recent evidence (search period 2004 - October 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: Provider Incentives – Cervical Cancer pdf icon [PDF - 237 kB].

The effectiveness of provider-directed interventions was determined by considering evidence across all three cancer screening sites combined, as long as there were not differences in effectiveness by screening test. This was done because provider behavior was thought to be less influenced than client behavior by the nature of screening tests.


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Summary of Results

Detailed results from the systematic review are available in the Task Force Finding and Rationale Statement pdf icon [PDF - 127 kB]

The review included five studies that assessed intervention effectiveness for breast, cervical, and colorectal cancers.

  • Screening completion for breast, cervical or colorectal cancer: median increase of 1.7 percentage points(interquartile interval: –0.1 to 3.6 percentage points; 7 study arms)
  • Completed cervical cancer screening by Pap test: estimated effects ranged from a 3.6 to 8.0 percentage point increase (2 study arms)

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 reviews of provider incentives to increase breast, cervical, and colorectal cancer screening.

The effectiveness of provider incentives in increasing colorectal, breast, and cervical cancer screening has not been established. Despite great interest in and use of provider incentives in many organized health systems (e.g., pay-for-performance models), relatively little published scientific information is available to assess the effectiveness of incentives in increasing screening for breast, cervical, and colorectal cancers. Several research questions remain.

  • Are provider incentives effective in increasing screening for colorectal, breast, and cervical cancers?
  • Do provider incentives incrementally increase the effectiveness of provider assessment and feedback interventions?
  • What are the most cost-effective approaches to reward cancer screening performance and/or referral by practitioners?
  • Do these interventions result in other positive or negative changes in health behavior or use of healthcare services?
  • 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 specific to one type of test as they are when addressing colorectal cancer screening more generally?

Study Characteristics

  • Physician settings ranged from large, multi-specialty organizations to individual practice associations or physician practices.
  • Included studies reported completed screenings or recommended or offered screenings.
  • Studies that reported completed screenings used medical records or performance reports to measure outcomes.
  • Incentives varied across studies.