title: Interventions targeted at women to encourage the uptake of cervical screening.
abstract: BACKGROUND
  World-wide, cervical cancer is the second most common cancer in women. Increasing the uptake of screening, alongside increasing informed choice is of great importance in controlling this disease through prevention and early detection.
  
  
  OBJECTIVE
  To assess the effectiveness of interventions aimed at women, to increase the uptake, including informed uptake, of cervical cancer screening.
  
  
  METHODS
  We searched the Cochrane Gynaecological Cancer Group Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL), Issue 1, 2009. MEDLINE, EMBASE and LILACS databases up to March 2009. We also searched registers of clinical trials, abstracts of scientific meetings, reference lists of included studies and contacted experts in the field.
  
  
  METHODS
  Randomised controlled trials (RCTs) of interventions to increase uptake/informed uptake of cervical cancer screening.
  
  
  METHODS
  Two review authors independently abstracted data and assessed risk of bias. Where possible the data were synthesised in a meta-analysis.
  
  
  RESULTS
  Thirty-eight trials met our inclusion criteria. These trials assessed the effectiveness of invitational and educational interventions, counselling, risk factor assessment and procedural interventions. Heterogeneity between trials limited statistical pooling of data. Overall, however, invitations appear to be effective methods of increasing uptake. In addition, there is limited evidence to support the use of educational materials. Secondary outcomes including cost data were incompletely documented so evidence was limited. Most trials were at moderate risk of bias. Informed uptake of cervical screening was not reported in any trials.
  
  
  CONCLUSIONS
  There is evidence to support the use of invitation letters to increase the uptake of cervical screening. There is limited evidence to support educational interventions but it is unclear what format is most effective. The majority of the studies are from developed countries and so the relevance to developing countries is unclear.
authors.affiliation: Department of Gynaecological Oncology, Addenbrooke's Hospital NHS Foundation Trust, BOX 242, Addenbrooke's Hospital, Hills Road, Cambridge, UK, CB2 0QQ.
authors.forename: Thomas
authors.initials: T
authors.lastname: Everett
authors.forename: Andrew
authors.initials: A
authors.lastname: Bryant
authors.forename: Michelle F
authors.initials: MF
authors.lastname: Griffin
authors.forename: Pierre Pl
authors.initials: PP
authors.lastname: Martin-Hirsch
authors.forename: Carol A
authors.initials: CA
authors.lastname: Forbes
authors.forename: Ruth G
authors.initials: RG
authors.lastname: Jepson
mesh_terms: D005260:Female; D006801:Humans; D008403:Mass Screening / Q000706:statistics & numerical data*; D010342:Patient Acceptance of Health Care; D011230:Precancerous Conditions / Q000175:diagnosis; D016032:Randomized Controlled Trials as Topic; D017010:Reminder Systems; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000517:prevention & control; D014626:Vaginal Smears / Q000706:statistics & numerical data*