Abstract
SummaryBackgroundIn England, participation in breast cancer screening has been decreasing in the past 10 years, approaching the national minimum standard of 70%. Interventions aimed at improving participation need to be investigated and put into practice to stop this downward trend. We assessed the effect on participation of sending invitations for breast screening with a timed appointment to women who did not attend their first offered appointment within the NHS Breast Screening Programme (NHSBSP).MethodsIn this open, randomised controlled trial, women in six centres in the NHSBSP in England who were invited for routine breast cancer screening were randomly assigned (1:1) to receive an invitation to a second appointment with fixed date and time (intervention) or an invitation letter with a telephone number to call to book their new screening appointment (control) in the event of non-attendance at the first offered appointment. Randomisation was by SX number, a sequential unique identifier of each woman within the NHSBSP, and at the beginning of the study a coin toss decided whether women with odd or even SX numbers would be allocated to the intervention group. Women aged 50–70 years who did not attend their first offered appointment were eligible for the analysis. The primary endpoint was participation (ie, attendance at breast cancer screening) within 90 days of the date of the first offered appointment; we used Poisson regression to compare the proportion of women who participated in screening in the study groups. All analyses were by intention to treat. This trial is registered with Barts Health, number 009304QM.FindingsWe obtained 33 146 records of women invited for breast cancer screening at the six centres between June 2, 2014, and Sept 30, 2015, who did not attend their first offered appointment. 26 054 women were eligible for this analysis (12 807 in the intervention group and 13 247 in the control group). Participation within 90 days of the first offered appointment was significantly higher in the intervention group (2861 [22%] of 12 807) than in the control group (1632 [12%] of 13 247); relative risk of participation 1·81 (95% CI 1·70–1·93; p<0·0001).InterpretationThese findings show that a policy of second appointments with fixed date and time for non-attenders of breast screening is effective in improving participation. This strategy can be easily implemented by the screening sites and, if combined with simple interventions, could further increase participation and ensure an upward shift in the participation trend nationally. Whether the policy should vary by time since last attended screen will have to be considered.FundingNational Health Service Cancer Screening Programmes and Department of Health Policy Research Programme.
Highlights
An important indicator of the public health impact of the National Health Service Breast Screening Programme (NHSBSP) in the UK is the participation rate, defined as the percentage of women invited for screening who are screened adequately within 180 days of invitation
We identified no trials of second timed appointments for non-attenders from outside the UK breast screening programme
Implications of all the available evidence Our findings show the positive effects of second timed appointments on attendance for breast cancer screenings
Summary
An important indicator of the public health impact of the National Health Service Breast Screening Programme (NHSBSP) in the UK is the participation rate, defined as the percentage of women invited for screening who are screened adequately within 180 days of invitation (usually referred to as uptake in official reports). The NHSBSP invites women aged 50–70 years to mammographic screening every 3 years. The invitation letter includes a screening appointment with a given date, time, and place. An age eligibility extension to invite women aged between 47 years and 73 years is currently being trialled.[4] The usual practice for non-attenders of the first offered appointment is to send www.thelancet.com/oncology Vol 18 July 2017
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