CDC COMMUNITY GUIDE: Breast Cancer Prevention & Control, Provider-Oriented Screening Interventions: Provider Reminder & Recall Systems

Multicomponent interventions to increase breast cancer screenings have the greatest effects on community health. Multicomponent interventions include: increasing community demand, access, and screening procedures and delivery in communities. Other approaches include:

• Interventions to increase community demand for cancer screening: client reminders, client incentives, small media, mass media, group education, and one-on-one education
• Interventions to increase community access to cancer screening: reducing structural barriers and reducing client out-of-pocket costs
• Interventions to increase provider delivery of screening services: provider assessment and feedback, provider incentives, and provider reminders

Reminders inform health care providers it is time for a client's cancer screening test (called a "reminder") or that the client is overdue for screening (called a "recall"). The reminders can be provided in different ways, such as in client charts or by e-mail.

The Community Preventive Services Task Force recommends provider reminder systems based on strong evidence of their effectiveness in increasing:
• Breast cancer screening by mammography

Additionally, it is recommended to design interventions that address and reduce structural barriers:
• Reducing administrative barriers
• Assisting with appointment scheduling
• Setting up alternative screening sites
• Adding screening hours
• Addressing transportation barriers
• Providing language translation services
• Offering child care

The goal of incorporating multicomponent interventions for cancer screenings is to increase breast cancer screenings in communities.

Multicomponent interventions that include strategies that reduce and address structural barriers increase cancer screening rates by the largest margins.

Results from the Systematic Review:
• Between January 2004 - November 2013 33 studies related to breast cancer were evaluated on the intervention effects related to screening services.
• Multicomponent breast cancer screening interventions increased screening by a median of 6.2 percentage points.
• Multicomponent breast cancer screening interventions that included the following components increased screening by a median of 24.2 percentage points: increasing community demand, increasing community access, or increasing provider delivery of screening
• When interventions only included increasing community demand and access, screening still increased by 11.2 percentage points
• Multicomponent interventions that included strategies that reduced structural barriers increased cancer screening rates by the largest margins: Providing language translation services led to the largest increase (median increase of 62.7 percentage points, 4 studies); and addressing transportation needs led to the next largest increase (median increase of 18.4 percentage points, 11 studies)