title: Pre-notification increases uptake of colorectal cancer screening in all demographic groups: a randomized controlled trial.
abstract: OBJECTIVE
  To assess whether pre-notification is effective in increasing uptake of colorectal cancer screening for all demographic groups.
  
  
  METHODS
  Scottish national colorectal cancer screening programme.
  
  
  METHODS
  Males and females aged 50-74 years received a faecal occult blood test by post to complete at home. They were randomized to receive in addition: the pre-notification letter, the pre-notification letter + information booklet, or the usual invitation. Overall, 59,953 subjects were included in the trial between 13/04/09 and 29/05/09 and followed to 27/11/09. Pre-notification letters were posted two weeks ahead of the screening test kit. Uptake was defined as the return of a screening test and chi-squared tests compared uptake between the trial arms. Logistic regression assessed the impact of the letter and letter + booklet on uptake independently of gender, age, deprivation and screening round.
  
  
  RESULTS
  Uptake was higher with both the letter (59.0%) and the letter + booklet (58.5%) compared with the usual invitation (53.9%, p < 0.0001). This increased uptake was seen for males, females, all age groups and all deprivation categories including least deprived females (letter 69.9%, usual invitation 66.6%) and most deprived males (42.6% vs. 36.1%), the groups with the highest and lowest levels of uptake respectively in the pilot screening rounds conducted prior to the roll out of the programme. Uptake with the pre-notification letter compared with the usual invitation was higher both unadjusted and adjusted for demographic factors (odds ratio 1.24, 95% CI 1.193-1.294).
  
  
  CONCLUSIONS
  Pre-notification is an effective method of increasing uptake in colorectal cancer screening for both genders and all age and deprivation groups.
authors.affiliation: Scottish Bowel Screening Centre, Kings Cross, Clepington Road, Dundee DD3 8EA. g.libby@dundee.ac.uk
authors.forename: Gillian
authors.initials: G
authors.lastname: Libby
authors.forename: Jane
authors.initials: J
authors.lastname: Bray
authors.forename: Jennifer
authors.initials: J
authors.lastname: Champion
authors.forename: Linda A
authors.initials: LA
authors.lastname: Brownlee
authors.forename: Janice
authors.initials: J
authors.lastname: Birrell
authors.forename: Dermot R
authors.initials: DR
authors.lastname: Gorman
authors.forename: Emilia M
authors.initials: EM
authors.lastname: Crighton
authors.forename: Callum G
authors.initials: CG
authors.lastname: Fraser
authors.forename: Robert J C
authors.initials: RJ
authors.lastname: Steele
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D003625:Data Collection / Q000379:methods*; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D005243:Feces; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009780:Occult Blood; D010342:Patient Acceptance of Health Care