title: Evaluating the effectiveness of cervical cancer screening invitation letters.
abstract: OBJECTIVE
  The objective of this study was to evaluate the effectiveness of an invitation letter on cervical screening participation among unscreened women 30 to 69 years of age.
  
  
  METHODS
  A cluster randomized trial design was used in which unscreened women (n=31,452) were randomized by the forward sortation area (FSA) of their postal code to an intervention group that was sent an invitation letter (n=17,068) or a group that was not sent an invitation letter (n=14,384).
  
  
  RESULTS
  Six months after the letters were mailed, 1,010 women in the intervention group (5.92%) and 441 women in the control group (3.06%) had a Pap test. After adjusting for variables that have previously shown to influence screening participation, women who were sent an invitation letter were significantly more likely to have had a Pap test in the next 6 months compared with women who were not sent an invitation letter (odds ratio [OR]=2.60, 95% confidence interval [CI] 2.09-3.35, p<0.001). Overall, the effectiveness of the invitation letter improved with increasing age (p=0.02).
  
  
  CONCLUSIONS
  Sending invitation letters increased cervical screening participation but because the overall effect was small, additional strategies that remove barriers to screening for unscreened women are also necessary.
authors.affiliation: Screening Programs, CancerCare Manitoba, Winnipeg Manitoba, Canada. kathleen.decker@cancercare.mb.ca
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Decker
authors.forename: Donna
authors.initials: D
authors.lastname: Turner
authors.forename: Alain A
authors.initials: AA
authors.lastname: Demers
authors.forename: Patricia J
authors.initials: PJ
authors.lastname: Martens
authors.forename: Pascal
authors.initials: P
authors.lastname: Lambert
authors.forename: Daniel
authors.initials: D
authors.lastname: Chateau
mesh_terms: D000328:Adult; D000368:Aged; D016000:Cluster Analysis; D057186:Comparative Effectiveness Research; D015709:Correspondence as Topic; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D005260:Female; D006293:Health Promotion / Q000379:methods; D006801:Humans; D008350:Manitoba; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D016017:Odds Ratio; D011159:Population Surveillance; D011177:Postal Service; D017064:Process Assessment, Health Care; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000517:prevention & control; D014626:Vaginal Smears / Q000706:statistics & numerical data*