Abstract
ObjectivesTo estimate the effect on breast screening uptake of delayed, targeted, second timed appointments in women who did not take up an initial breast cancer screening appointment offer.MethodsNon-attending women received a four-month delayed second timed appointment following non-response to the initial invitation and the normal open invitation sent to non-attenders. A comparison group was sent a four-month delayed additional open invitation.ResultsResponse to the second timed appointments (percentage of re-invited women eventually attending in this episode) was 20%, corresponding to an estimated increase on total uptake of 6%. Response was highest in women who had previously attended screens. Response in the women offered an additional delayed open invitation was 7.5%, corresponding to an estimated 2.3% increase in overall uptake.ConclusionsSecond timed appointments were almost three times as effective as additional open invitation. They should be targeted at women most likely to attend. A randomized study of second timed appointments versus open invitations should be conducted.
Highlights
Screening for breast cancer has been shown to reduce deaths due to the disease, the magnitude of side-effects such as over-diagnosis remains uncertain.[1]
The overall response rate to the additional open invitation sent to non-attenders was 8% (160 women attended within six months of their open episode date, out of 2127 open invitations sent), which was significantly less than 2TAs (p < 0.01), women were not randomized between 2TAs and open appointments
We found that four-month delayed 2TAs sent to non-attenders had nearly three times the response rate in comparison with additional four-month delayed open invitations (20% vs. 7.5%), which yielded a correspondingly larger increase in service-wide uptake
Summary
Screening for breast cancer has been shown to reduce deaths due to the disease, the magnitude of side-effects such as over-diagnosis remains uncertain.[1]. The lower uptake in London is thought to be due in part to the increased population mobility and, women not receiving their invitations,[2] lower socioeconomic status and lower uptake in certain ethnic groups.[3,4,5,6,7]. DNA women were sent a standard open invitation. As a large number of second invitations will be missed, wasting both time and resources, it was of interest to examine the effectiveness of targeting invitations to particular groups of women (in terms of their age, whether they were being invited to prevalent (first) or incident (subsequent) screens, and in the case of the latter, the length of time since the woman last attended a screen)
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