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Cancer Screening: Small Media Targeting Clients – Breast Cancer


What the CPSTF Found

About The Systematic Review

The CPSTF finding is based on evidence from a systematic review of 19 studies (search period 1966 - 2004). The review was 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.

Summary of Results

Detailed results from the systematic review are available in the published evidence review pdf icon [PDF - 1.05 MB].

Nineteen studies qualified for the systematic review.

  • Mammography screening: median increase of 7.0 percentage points (interquartile interval [IQI]: 0.3 to 13.2 percentage points; 21 study arms)
  • Interventions were effective when tailored: 7.0 percentage point median increase (IQI: –4.5 to 11.2 percentage points; 7 study arms)
  • Interventions also were effective when untailored: 4.7 percentage point median increase (IQI: 0.5 to 13.4 percentage points; 14 study arms)

Summary of Economic Evidence

Detailed results from the systematic review are available in the published evidence review pdf icon [PDF - 1.05 MB].

Five studies qualified for the review and reported a wide range of cost effectiveness estimates based on different metrics and assumptions.


Findings should apply to both tailored and untailored interventions across a range of populations and settings, provided the intervention is appropriately adapted to the target population and delivery context.

Evidence Gaps

The CPSTF identified several areas that have limited information. Additional research and evaluation could help answer the following questions and fill remaining gaps in the evidence base. (What are evidence gaps?)

  • Does effectiveness of small media differ by choice of medium (e.g., letter, video, brochure, or Internet-delivered application), information source (e.g., personal physician, educator), or intensity or frequency of delivery?
  • What is the relative cost effectiveness of tailored versus untailored messages?
  • How does the effectiveness of interventions to increase community demand for screening vary with the health literacy of a target population or subpopulation?
  • How can newer methods of communication—including automated telephone calls and Internet-delivered applications—be used to improve delivery, acceptance, and effectiveness of these interventions?
  • How effective are these interventions in increasing screening by colorectal endoscopy or by double contrast barium enema (for which no qualifying studies were identified)?
  • What is required to disseminate and implement effective interventions in community settings across the United States?
  • How can or should these approaches be applied to assure that screening, once initiated, is maintained at recommended intervals?
  • With respect to interventions that may be tailored to individuals, how are effective tailoring programs adapted, disseminated, and implemented in community-based settings across the United States?

Study Characteristics

  • Tailored interventions used booklets, personalized letters, or other printed materials.
  • Untailored interventions used personal checklists or record-keeping booklets, printed information distributed at medical facilities, informational or motivational posters and videos in patient waiting or other areas, letters, or a video with brochures.
  • Reviewed studies were conducted in both rural and urban communities and among different racial, ethnic, and socioeconomic groups.