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Cancer Screening: Client Reminders – Colorectal Cancer by Fecal Occult Blood Test (FOBT)


What the CPSTF Found

About The Systematic Review

The Task Force finding is based on evidence from a Community Guide systematic review published in 2008 (Baron et al., 4 studies, search period 1966-2004) combined with more recent evidence (3 studies, search period 2004-2008). The systematic review was 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. This finding updates and replaces the 2008 Task Force finding on Cancer Screening: Client Reminders – Colorectal Cancer by FOBT [PDF - 305 kB].


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Summary of Results

Results from the 2008 Review

The original colorectal cancer review included 4 studies.

  • Screening by fecal occult blood test (FOBT): median increase of 11.5 percentage points (interquartile interval [IQI]: 8.9 to 20.3 percentage points; 8 study arms).

Results from 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 with 9 study arms)


Summary of Economic Evidence

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.


Tailored and untailored client reminder interventions to increase colorectal cancer screening by FOBT should be applicable across a range of settings and populations, provided they are adapted and targeted for a specific population and delivery context.

Evidence Gaps

Each Community Preventive Services Task Force (Task Force) review identifies critical evidence gaps—areas where information is lacking. Evidence gaps can exist whether or not a recommendation is made. In cases when the Task Force finds insufficient evidence to determine whether an intervention strategy works, evidence gaps encourage researchers and program evaluators to conduct more effectiveness studies. When the Task Force recommends an intervention, evidence gaps highlight missing information that would help users determine if the intervention could meet their particular needs. For example, evidence may be needed to determine where the intervention will work, with which populations, how much it will cost to implement, whether it will provide adequate return on investment, or how users should structure or deliver the intervention to ensure effectiveness. Finally, evidence may be missing for outcomes different from those on which the Task Force recommendation is based.

Identified Evidence Gaps

The following outlines evidence gaps for client reminders to increase breast, cervical, or colorectal cancer screening.

  • How do newer methods of communication (e.g., the Internet, e-mail, text messages, or automated telephone calls) influence the effectiveness of client reminder interventions?
  • To what extent does effectiveness vary for groups overdue for screening or never screened?
  • Does effectiveness vary according to the source of client reminders (e.g., clinic or practice versus screening registry or program)?
  • Do reminders for screenings for multiple cancer sites work as well as those for a single cancer site?
  • Are interventions effective for promoting colorectal cancer screening with methods other than FOBT?
  • Are interventions to promote colorectal cancer screening equally effective when addressing colorectal cancer screening more generally, as when specific to one type of test?
  • What are the incremental effects of adding intervention components to other interventions?
  • What is the influence of health system factors on intervention effectiveness?

Study Characteristics

Following are characteristics of included studies from the updated search period.

  • Interventions used print reminders. None were tailored and two were enhanced.
  • Reminders were delivered by clinical practices or organizations, or screening programs.
  • Outcomes were assessed by survey and medical record review.
  • Where specified, interventions were conducted in the U.S. and Italy.
  • One study reported including nonwhite participants, although it did not provide more specific information, and two studies reported including mixed urban/rural or non-urban populations.