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

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.

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

The original review included 22 studies and 38 study arms. 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 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.

Cervical Cancer


Results of the Original Review

 

The original cervical cancer screening review included 11 studies with 15 study arms.

  • 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; 9 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

Colorectal Cancer


Results of the Original Review

 

The original colorectal cancer review included 4 studies with 8 study arms.

  • Screening by fecal occult blood test (FOBT): median increase of 11.5 percentage points (IQI: 8.9 to 20.3 percentage points).

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.

image of planet Find Research-Tested Intervention Programs (RTIPs) about the use of client reminders to increase breast External Web Site Icon, cervical External Web Site Icon, and colorectal External Web Site Icon cancer screening (What is an RTIP?).

Supporting Materials

Publications

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.

 




Disclaimer

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: client reminders. http://www.thecommunityguide.org/cancer/screening/client-oriented/reminders.html. Last updated: MM/DD/YYYY.

Review completed: July 2010