title: Improving breast screening uptake: persuading initial non-attenders to attend.
abstract: OBJECTIVE
  Firstly, to determine whether the acceptance rate of the second invitation for breast screening (sent to women who have failed to attend after the first invitation) might be increased by an accompanying letter from a general practitioner (GP letter). Secondly, to identify the additional costs of sending such a letter.
  
  
  METHODS
  465 women registered with four practices in a single health centre were recruited into a randomised controlled trial in which the intervention was the inclusion of a standard, photocopied letter signed by the non-attender's doctor with the second invitation to attend for breast screening. The control group received only the standard invitation from the breast screening centre. The costs associated with the intervention were assessed from data supplied by the breast screening centre, supplemented by direct observation of the preparation of second invitations and semistructured interviews with the staff taking part.
  
  
  RESULTS
  The attendance rate of the test group one month after the second invitation for screening was significantly higher than that of the control group (21% v 10%, P < 0.01). The average cost of a GP letter included with the invitation was 1.1 pence and the marginal cost for each extra attender was 9.6 pence. No non-monetary costs were identified.
  
  
  CONCLUSIONS
  The inclusion of a GP letter appeared to be effective and feasible in increasing the attendance rate to the second invitation. This intervention should be tested in other screening groups to confirm the effectiveness of a GP letter and its cost effectiveness.
authors.affiliation: Department of Public Health, University of Aberdeen Medical School, Foresterhill, United Kingdom.
authors.forename: K M
authors.initials: KM
authors.lastname: Turner
authors.forename: B J
authors.initials: BJ
authors.lastname: Wilson
authors.forename: F J
authors.initials: FJ
authors.lastname: Gilbert
mesh_terms: D001943:Breast Neoplasms / Q000517:prevention & control*; D015709:Correspondence as Topic; D003365:Costs and Cost Analysis; D005194:Family Practice; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008327:Mammography; D008403:Mass Screening / Q000191:economics / Q000523:psychology* / Q000706:statistics & numerical data*; D008875:Middle Aged; D010349:Patient Compliance; D012606:Scotland; D016312:Treatment Refusal