title: Improving breast and colon cancer screening rates: a comparison of letters, automated phone calls, or both.
abstract: OBJECTIVE
  Low-cost interventions to improve cancer screening among primary care patients are needed. The comparative effectiveness of personalized letters, automated telephone calls, and both on breast cancer (BC) and colorectal cancer (CRC) screening is not known.
  
  
  METHODS
  A pragmatic, randomized, controlled trial was conducted in 2011 to 2012. Eligible primary care patients were women ages 50 to 74 years who were past due for mammography and men or women who were past due for mammography or CRC screening of any kind (>12 months since last fecal occult blood test, >5 years since last sigmoidoscopy/double-contrast barium enema, or >10 years since last colonoscopy), respectively. Participants were randomized to 1 of 3 interventions: personalized mailed letters, automated telephone calls, or both. The primary outcome was medical record documentation of a completed mammogram or CRC screening within 36 weeks of randomization. We estimated the costs of each intervention and calculated the marginal cost-effectiveness per person screened.
  
  
  RESULTS
  The crude screening rates for BC were 19%, 22%, and 37% and for CRC were 17%, 14%, and 24% for the letter, automated call, and combined (letter/automated call) groups, respectively. The combined intervention group had a statistically higher screening rate (P < .05) compared with either of the single intervention groups (letter only or automated call) for both BC and CRC in both the crude and adjusted analyses. The combined intervention costs $5.11 per additional person screened for BC and $13.14 per additional person screened for CRC.
  
  
  CONCLUSIONS
  In a primary care practice, letters plus automated telephone calls are better than either alone in increasing cancer screening rates among patients who are overdue for screening. These findings suggest the promise of a relatively inexpensive intervention to improve cancer screening.
authors.affiliation: From the Department of Family Medicine, University of Rochester Medical Center, Rochester, NY (LP, PW, KF); the Department of Surgery, University of Michigan, Ann Arbor (S. Hendren); and the Department of Pediatrics, Children's Mercy Hospitals and Clinics, Kansas City, MO (S. Humiston).
authors.forename: Lindsay
authors.initials: L
authors.lastname: Phillips
authors.affiliation: From the Department of Family Medicine, University of Rochester Medical Center, Rochester, NY (LP, PW, KF); the Department of Surgery, University of Michigan, Ann Arbor (S. Hendren); and the Department of Pediatrics, Children's Mercy Hospitals and Clinics, Kansas City, MO (S. Humiston).
authors.forename: Samantha
authors.initials: S
authors.lastname: Hendren
authors.affiliation: From the Department of Family Medicine, University of Rochester Medical Center, Rochester, NY (LP, PW, KF); the Department of Surgery, University of Michigan, Ann Arbor (S. Hendren); and the Department of Pediatrics, Children's Mercy Hospitals and Clinics, Kansas City, MO (S. Humiston).
authors.forename: Sharon
authors.initials: S
authors.lastname: Humiston
authors.affiliation: From the Department of Family Medicine, University of Rochester Medical Center, Rochester, NY (LP, PW, KF); the Department of Surgery, University of Michigan, Ann Arbor (S. Hendren); and the Department of Pediatrics, Children's Mercy Hospitals and Clinics, Kansas City, MO (S. Humiston).
authors.forename: Paul
authors.initials: P
authors.lastname: Winters
authors.affiliation: From the Department of Family Medicine, University of Rochester Medical Center, Rochester, NY (LP, PW, KF); the Department of Surgery, University of Michigan, Ann Arbor (S. Hendren); and the Department of Pediatrics, Children's Mercy Hospitals and Clinics, Kansas City, MO (S. Humiston). Kevin_Fiscella@urmc.rochester.edu.
authors.forename: Kevin
authors.initials: K
authors.lastname: Fiscella
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging; D015179:Colorectal Neoplasms / Q000175:diagnosis; D005260:Female; D006801:Humans; D008297:Male; D008327:Mammography / Q000706:statistics & numerical data; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D011320:Primary Health Care / Q000379:methods*; D017010:Reminder Systems
keywords: Cancer Screening; Colorectal Cancer; Mammography