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Celebrate 10 Years with Cancer Control P.L.A.N.E.T.

Increasing Cancer Screening: Reducing Client Out-of-Pocket Costs

Interventions to reduce client out-of-pocket costs attempt to minimize or remove economic barriers that make it difficult for clients to access cancer screening services. Costs can be reduced through a variety of approaches, including vouchers, reimbursements, reduction in co-pays, or adjustments in federal or state insurance coverage. Efforts to reduce client costs may be combined with measures to provide client education, information about program availability, or measures to reduce structural barriers.

Summary of Task Force Recommendations and Findings

The Community Preventive Services Task Force recommends reducing client out-of-pocket costs for breast cancer screening on the basis of sufficient evidence of effectiveness in increasing screening for breast cancer.

The Task Force finds insufficient evidence to determine the effectiveness of reducing out-of-pocket costs in increasing screening for cervical or colorectal cancer because too few (cervical cancer) or no (colorectal cancer) studies were identified. Nonetheless, the consistent favorable results for interventions that reduce costs for breast cancer screening and several other preventive services suggest that such interventions are likely to be effective for increasing cervical and colorectal cancer screening as well.

Task Force Finding and Rationale Statement

Results from the Systematic Reviews

The Task Force findings are based on evidence from a previously completed review (search period 1966-2004) and an updated review (search period 2004-2008). Updates of reviews are conducted to incorporate more recent evidence.

Read a summary of findings from the previous review or visit the Cancer Prevention and Control section of our publications page to access the complete articles.

Breast Cancer

Eight studies qualified for the original systematic review; no new studies were identified for the update.

  • Mammography screening: median increase of 11.5 percentage points (interquartile interval [IQI]: 6.0-28.5; 8 studies).
  • Six studies evaluated the extension of Medicare or state benefits to cover periodic mammography and two assessed the use of free client vouchers.

Findings should be applicable to various populations and settings in which people would accept screening but have limited financial resources.

Cervical Cancer

One study qualified for the original systematic review; no new studies were identified for the update.

  • Pap tests: reported increase of 17 percentage points

Colorectal Cancer

No studies qualified for the review.

These findings were based on a systematic review of all available studies, 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.

Economic Review

An economic review of this intervention did not find any relevant studies.

image of planetFind a Research-Tested Intervention Program External Web Site Icon(RTIP) about reducing out-of-pocket costs to increase breast cancer screening (What is an RTIP?).

Supporting Materials


Sabatino SA, Lawrence B, Elder R, Mercer SL, Wilson KM, DeVinney B, Melillo S, Carvalho M, Taplin S, Bastani R, Rimer BK, Vernon SW, Melvin CL, Taylor V, Fernandez M, Glanz K, Community Preventive Services Task Force. Effectiveness of interventions to increase screening for breast, cervical, and colorectal cancers: nine updated systematic reviews for The Guide to Community Preventive Services. Adobe PDF File [PDF - 235 kB] Am J Prev Med 2012;43(1):765-86.

Community Preventive Services Task Force. Updated recommendations for client- and provider-oriented interventions to increase breast, cervical, and colorectal cancer screening. Adobe PDF File [PDF - 90 kB]. Am J Prev Med 2012;43(1):760-4.

Read other Community Guide publications about Cancer Prevention and Control in our library.


The findings and conclusions on this page are those of the Community Preventive Services Task Force and do not necessarily represent those of CDC. Task Force evidence-based recommendations are not mandates for compliance or spending. Instead, they provide information and options for decision makers and stakeholders to consider when determining which programs, services, and policies best meet the needs, preferences, available resources, and constraints of their constituents.

Sample Citation

The content of publications of the Guide to Community Preventive Services is in the public domain. Citation as to source, however, is appreciated. Sample citation: Guide to Community Preventive Services. Increasing cancer screening: reducing client out-of-pocket costs. Last updated: MM/DD/YYYY.

Review completed: October 2009