Increasing Cancer Screening: Client Reminders
Client reminders are written (letter, postcard, email) or telephone messages (including automated messages) advising people that they are due for screening. Client reminders may be enhanced by one or more of the following:
- Follow-up printed or telephone reminders
- Additional text or discussion with information about indications for, benefits of, and ways to overcome barriers to screening
- Assistance in scheduling appointments
These interventions can be untailored to address the overall target population or tailored with the intent to reach one specific person, based on characteristics unique to that person, related to the outcome of interest, and derived from an individual assessment.
Summary of Task Force Recommendations and Findings
The Community Preventive Services Task Force recommends the use of client reminders to increase screening for breast and cervical cancers on the basis of strong evidence of effectiveness. The Task Force also recommends the use of client reminders to increase colorectal cancer screening with fecal occult blood testing based on strong evidence of effectiveness.
Evidence is insufficient, however, to determine effectiveness of client reminders in increasing colorectal cancer screening with other tests (colonoscopy, flexible sigmoidoscopy), because of inconsistent evidence.
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.
The original 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).
Client reminder interventions to increase breast cancer screening should be applicable across a range of settings and populations, provided they are adapted to the target population and delivery context.
Results of the Original Review
The original cervical cancer screening review included 11.
- Pap test: median increase of 10.2 percentage points (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 of 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).
Client reminder interventions to increase cervical cancer screening should be applicable across a range of settings and populations, provided they are adapted to the target population and delivery context
Results of the Original Review
The original colorectal cancer review included 4 studies.
- Screening by fecal occult blood test (FOBT): median increase of 11.5 percentage points (IQI: 8.9 to 20.3 percentage points, 8 study arms).
Results of the Updated Review
The updated review included 3 additional studies. 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 (IQI 6.0 to 13.5 percentage points; 5 studies, 9 intervention arms)
- The estimated effect for other types of colorectal screening was low.
Client reminder interventions to increase colorectal cancer screening by FOBT should be applicable across a range of settings and populations, provided they are adapted to the target population and delivery context.
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.
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.
- Analytic Framework – see Figure 1 on page 100 [PDF - 230 kB]
- Evidence Gaps
- Summary Evidence Tables - Effectiveness Review
- Breast Cancer [PDF - 142 kB]
- Cervical Cancer [PDF - 138 kB]
- Colorectal Cancer by Colonoscopy or Flexible Sigmoidoscopy [PDF - 103 kB]
- Colorectal Cancer by Fecal Occult Blood Test [PDF - 118 kB]
- Summary Evidence Table - Economic Review [PDF - 89 kB]
- Included Studies - Economic Review
- Search Strategy
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. [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. [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.
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: client reminders. http://www.thecommunityguide.org/cancer/screening/client-oriented/reminders.html. Last updated: MM/DD/YYYY.
Review completed: July 2010
- Page last reviewed: April 19, 2016
- Page last updated: April 19, 2016
- Content source: The Guide to Community Preventive Services