Journal of General Internal Medicine

, Volume 29, Issue 1, pp 41–49

Randomized, Controlled Trial of a Multimodal Intervention to Improve Cancer Screening Rates in a Safety-Net Primary Care Practice

  • Samantha Hendren
  • Paul Winters
  • Sharon Humiston
  • Amna Idris
  • Shirley X. L. Li
  • Patricia Ford
  • Raymond Specht
  • Stephen Marcus
  • Michael Mendoza
  • Kevin Fiscella



Cancer screening rates are suboptimal for low-income patients.


To assess an intervention to increase cancer screening among patients in a safety-net primary care practice.


Patients at an inner-city family practice who were overdue for cancer screening were randomized to intervention or usual care. Screening rates at 1 year were compared using the chi-square test, and multivariable analysis was performed to adjust for patient factors.


All average-risk patients at an inner-city family practice overdue for mammography or colorectal cancer (CRC) screening. Patients’ ages were 40 to 74 years (mean 53.9, SD 8.7) including 40.8 % African Americans, 4.2 % Latinos, 23.2 % with Medicaid and 10.9 % without any form of insurance.


The 6-month intervention to promote cancer screening included letters, automated phone calls, prompts and a mailed Fecal Immunochemical Testing (FIT) Kit.

Main Measures

Rates of cancer screening at 1 year.

Key Results

Three hundred sixty-six patients overdue for screening were randomly assigned to intervention (n = 185) or usual care (n = 181). Primary analysis revealed significantly higher rates of cancer screening in intervention subjects: 29.7 % vs. 16.7 % for mammography (p = 0.034) and 37.7 % vs. 16.7 % for CRC screening (p = 0.0002). In the intervention group, 20 % of mammography screenings and 9.3 % of CRC screenings occurred at the early assessment, while the remainder occurred after repeated interventions. Within the CRC intervention group 44 % of screened patients used the mailed FIT kit. On multivariable analysis the CRC screening rates remained significantly higher in the intervention group, while the breast cancer screening rates were not statistically different.


A multimodal intervention significantly increased CRC screening rates among patients in a safety-net primary care practice. These results suggest that relatively inexpensive letters and automated calls can be combined for a larger effect. Results also suggest that mailed screening kits may be a promising way to increase average-risk CRC screening.


breast neoplasms colorectal neoplasms cancer screening healthcare disparities 


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Copyright information

© Society of General Internal Medicine 2013

Authors and Affiliations

  • Samantha Hendren
    • 2
  • Paul Winters
    • 3
  • Sharon Humiston
    • 4
  • Amna Idris
    • 3
  • Shirley X. L. Li
    • 5
  • Patricia Ford
    • 3
  • Raymond Specht
    • 3
  • Stephen Marcus
    • 3
  • Michael Mendoza
    • 1
  • Kevin Fiscella
    • 1
    • 5
  1. 1.Department of Family MedicineUniversity of Rochester School of Medicine and DentistryRochesterUSA
  2. 2.Department of SurgeryUniversity of MichiganAnn ArborUSA
  3. 3.Department of Family MedicineHighland HospitalRochesterUSA
  4. 4.Department of PediatricsChildren’s Mercy Hospitals and ClinicsKansasUSA
  5. 5.Department of Community and Preventive MedicineUniversity of Rochester School of Medicine and DentistryRochesterUSA

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