Promoting participation in a population screening program for breast and cervical cancer: a randomized trial of different invitation strategies.
OBJECTIVE
Attendance level has been identified as a major determinant of cost-effectiveness of organized screening programs. We tested the effectiveness of 4 different invitation systems in the context of an organized population screening program for cervical and breast cancer.


METHODS
Women eligible for invitation--8385 for cervical and 8069 for breast cancer screening--listed in the rosters of 43 and 105 general practitioners (GP), respectively, who had accepted to collaborate in the program, were randomized to 4 invitation groups: Group A--letter signed by the GP, with a prefixed appointment; Group B--open-ended invitation, signed by the GP, prompting women to contact the screening center to arrange an appointment; Group C--letter (same as for group A), signed by the program coordinator, with a prefixed appointment; Group D--extended letter (highlighting the benefits of early cancer detection) signed by the GP, with a prefixed appointment. Assignment to the interventions was based on a randomized block design (block=GP).


RESULTS
Assuming Group A as the reference, the overall compliance with cervical cancer screening was reduced by 39% in Group B (RR=0.61; 95% CI, 0.56-0.68) and by 14% in Group C (RR=0.86; 95% CI, 0.78-0.93); no difference was observed for Group D (RR=1.03; 95% CI, 0.95-1.1). The response pattern was similar for breast screening (Group B: RR=0.71; 95% CI, 0.65-0.76; Group C: RR=0.87; 95% CI, 0.81-0.94; Group D: RR=1.01; 95% CI, 0.94-1.08).


CONCLUSIONS
Personal invitation letters signed by the woman's GP, with preallocated appointments, induce a significant increase in compliance with screening. Efficiency can be ensured through the adoption of overbooking, provided that attendance levels are regularly monitored.
C.P.O. Piemonte, Dipartimento di Oncologia, Ospedale S. Giovanni AS, Azienda USLI, Torino, Italy.
N
N
Segnan
C
C
Senore
L
L
Giordano
A
A
Ponti
G
G
Ronco
D000328:Adult; D001943:Breast Neoplasms / Q000175:diagnosis / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007558:Italy; D008403:Mass Screening; D008875:Middle Aged; D010349:Patient Compliance; D018579:Patient Selection; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000517:prevention & control*