title: Effect size and cost-effectiveness estimates of breast and cervical cancer screening reminders by population size through complete enumeration of Japanese local municipalities.
abstract: BACKGROUND
  Client reminders are known to increase cancer screening attendance rates. However, there are significant costs associated with them, and their effect by population size is unknown.
  
  
  METHODS
  In 2007 and 2008, the Japanese Government surveyed breast and cervical cancer screening in every municipality in Japan. From the results, we selected all 1,464 municipalities that carried out both screening types. We examined whether changes in screening attendance rates between 2007 and 2008 were associated with client reminders, number of public health nurses per 100,000 population, financial strength index, and 2007 attendance rates for different population sizes. We then calculated cost-effectiveness estimates of client reminders by population size and screening type.
  
  
  RESULTS
  Client reminders were associated with increased attendance rates in populations <100,000. For populations of 50,000-100,000, there was a 2.76% increase in breast cancer screening (95% CI: 0.41, 5.11), and a 2.25% increase in cervical cancer screening (95% CI: 0.89, 3.61). The incremental cost per additional attendance was higher in populations <50,000 than in populations of 50,000-100,000 (breast, $100 versus $54; cervical, $149 versus $67 respectively).
  
  
  CONCLUSIONS
  Client reminders for breast and cervical cancer screening increased attendance rates in smaller municipalities in Japan.
authors.affiliation: Department of Preventive Medicine and Public Health, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan. komoto97@yahoo.co.jp.
authors.forename: Shigekazu
authors.initials: S
authors.lastname: Komoto
authors.forename: Yuji
authors.initials: Y
authors.lastname: Nishiwaki
authors.forename: Tomonori
authors.initials: T
authors.lastname: Okamura
authors.forename: Hideo
authors.initials: H
authors.lastname: Tanaka
authors.forename: Toru
authors.initials: T
authors.lastname: Takebayashi
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000175:diagnosis*; D002947:Cities; D003362:Cost-Benefit Analysis; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D007564:Japan; D011156:Population Density; D017010:Reminder Systems / Q000191:economics*; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*