title: Advance notification letters increase adherence in colorectal cancer screening: a population-based randomized trial.
abstract: OBJECTIVE
  The population benefit of screening depends not only on the effectiveness of the test, but also on adherence, which, for colorectal cancer (CRC) screening remains low. An advance notification letter may increase adherence, however, no population-based randomized trials have been conducted to provide evidence of this.
  
  
  METHODS
  In 2008, a representative sample of the Dutch population (aged 50-74 years) was randomized. All 2493 invitees in group A were sent an advance notification letter, followed two weeks later by a standard invitation. The 2507 invitees in group B only received the standard invitation. Non-respondents in both groups were sent a reminder 6 weeks after the invitation.
  
  
  RESULTS
  The advance notification letters resulted in a significantly higher adherence (64.4% versus 61.1%, p-value 0.019). Multivariate logistic regression analysis showed no significant interactions between group and age, sex, or socio-economic status. Cost analysis showed that the incremental cost per additional detected advanced neoplasia due to sending an advance notification letter was € 957.
  
  
  CONCLUSIONS
  This population-based randomized trial demonstrates that sending an advance notification letter significantly increases adherence by 3.3%. The incremental cost per additional detected advanced neoplasia is acceptable. We therefore recommend that such letters are incorporated within the standard CRC-screening invitation process.
authors: Department of Gastroenterology and Hepatology, Erasmus University Medical Centre,'s Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands. a.vanroon@erasmusmc.nl
authors: A H C
authors: AH
authors: van Roon
authors: L
authors: L
authors: Hol
authors: J A
authors: JA
authors: Wilschut
authors: J C I Y
authors: JC
authors: Reijerink
authors: A J
authors: AJ
authors: van Vuuren
authors: M
authors: M
authors: van Ballegooijen
authors: J D F
authors: JD
authors: Habbema
authors: M E
authors: ME
authors: van Leerdam
authors: Ernst J
authors: EJ
authors: Kuipers
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000191:economics / Q000517:prevention & control*; D003362:Cost-Benefit Analysis; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000191:economics / Q000706:statistics & numerical data*; D008875:Middle Aged; D009426:Netherlands; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D017010:Reminder Systems / Q000191:economics / Q000706:statistics & numerical data*