Recruitment to mammography screening: a randomised trial and meta-analysis of invitation letters and telephone calls.
OBJECTIVE
To determine the effectiveness of three recruitment strategies to encourage women to attend for an initial mammography screen, and to compare results with similar service studies. Interventions were: (1) an invitation letter; (2) two invitation letters; and (3) an invitation letter plus a follow-up telephone call.


METHODS
All women aged 50-54 years in two BreastScreen New South Wales (BSNSW) Screening and Assessment Service catchment areas (n=3,144) were recruited from the Australian Electoral Roll and randomised to the four groups. Response rates for each intervention were compared relative to standard practice (one invitation letter) at 12-weeks follow-up. Marginal cost-effectiveness for each condition was calculated. Other similar randomised trials were also meta-analysed.


RESULTS
The screening rate for two letters was 8.5% (OR=1.61, 95% CI 1.08-2.40) and 7.8% (OR=1.46, 95% CI 0.97-2.18) for one letter plus a telephone call, compared with 5.5% for standard practice (one letter) (OR=1.00). The response rate in the one letter plus a phone call group was 13.3% (OR=2.65, 95% CI 1.76-4.00) for women where a phone number was located.


CONCLUSIONS
Initial screening rates after a 12-week follow-up were significantly higher in the women receiving a second invitation letter, compared with standard practice (one letter). Marginal cost-effectiveness favoured the two-letter approach.


CONCLUSIONS
A follow-up invitation letter is more cost-effective than one invitation letter plus a follow-up telephone call in the BSNSW program. However, an invitation letter plus follow-up phone call is more cost-effective in recruiting women to BSNSW only if a phone number is located.
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Andrew
A
State Co-ordination Unit, BreastScreen New South Wales.
Morrell
Stephen
S
Chiu
Clayton
C
Taylor
Richard
R
Tewson
Richard
R