title: Invitation strategies for colorectal cancer screening programmes: The impact of an advance notification letter.
abstract: OBJECTIVE
  To estimate the impact of an advance notification letter on participation in sigmoidoscopy (FS) and fecal immunochemical test (FIT) screening.
  
  
  METHODS
  Eligible subjects, invited in 3 Italian population based programmes using FS and in 5 using FIT, were randomised (1:1:1), within GP, to: A) standard invitation letter; B) advance notification followed after 1month by the standard invitation; and C) B+indication to contact the general practitioner (GP) to get advice about the decision to be screened. We calculated the 9-month attendance and the incremental cost of each strategy. We conducted a phone survey to assess GP's utilization and predictors of participation.
  
  
  RESULTS
  The advance notification was associated with a 20% increase in the attendance among 15,655 people invited for FS (B vs A - RR: 1.17, 95% CI: 1.10-1.25; C vs A - RR: 1.19, 95% CI: 1.12-1.27); the incremental cost ranged between 10 and 9 Euros. Participation in FIT screening (N=23,543) was increased only with simple pre-notification (B vs A - RR: 1.06, 95% CI: 1.02-1.10); the incremental cost was 22.5 Euros. GP consultation rate was not increased in group C.
  
  
  CONCLUSIONS
  An advance notification represents a cost-effective strategy to increase participation in FS screening; its impact on the response to FIT screening was limited.
authors.affiliation: AOU Città della Salute e della Scienza, CPO Piemonte, Via San Francesco da Paola 31, Torino, Italy. Electronic address: carlo.senore@cpo.it.
authors.forename: Carlo
authors.initials: C
authors.lastname: Senore
authors.affiliation: Ospedale Fracastoro, UO Gastroenterologia, Via Circonvallazione 1, S Bonifacio, VE, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Ederle
authors.affiliation: UO Gastroenterologia, Ospedale S Chiara, Largo Medaglie d'Oro 9, Trento, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: DePretis
authors.affiliation: Unversità del Piemonte Orientale, CPO Piemonte, Via Solaroli 1, Novara, Italy.
authors.forename: Corrado
authors.initials: C
authors.lastname: Magnani
authors.affiliation: SS Programma di Screening Oncologici AUSL Rimini, Via Coriano 38, Rimini, Italy.
authors.forename: Debora
authors.initials: D
authors.lastname: Canuti
authors.affiliation: ASL Città di Milano, Servizio di Epidemiologia, Corso Italia 19, Milano, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Deandrea
authors.affiliation: Registro Tumori del Veneto, Passaggio Gaudenzio 1, Padova, Italy.
authors.forename: Manuel
authors.initials: M
authors.lastname: Zorzi
authors.affiliation: Regione Lazio, Direzione Regionale Salute e Integrazione Sociosanitaria, Via Rosa Raimondi Garibaldi 7, Rome, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Barca
authors.affiliation: UVOS, ASL Novara, Novara, Italy.
authors.forename: Piero
authors.initials: P
authors.lastname: Bestagini
authors.affiliation: UO Gastroenterologia, Ospedale S Chiara, Largo Medaglie d'Oro 9, Trento, Italy.
authors.forename: Katia
authors.initials: K
authors.lastname: Faitini
authors.affiliation: ASL Città di Milano, Servizio di Epidemiologia, Corso Italia 19, Milano, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Bisanti
authors.affiliation: SS Programma di Screening Oncologici AUSL Rimini, Via Coriano 38, Rimini, Italy.
authors.forename: Coralba
authors.initials: C
authors.lastname: Casale
authors.affiliation: Dipartimento di Prevenzione, ASL 17 di Este Monselice, Via Francesconi 2, Este, PD, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Ferro
authors.affiliation: Servizio Interaziendale Epidemiologia, AUSL Reggio Emilia, Via Amendola 2, Reggio Emilia, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: GiorgiRossi
authors.affiliation: Regione Lazio, Direzione Regionale Salute e Integrazione Sociosanitaria, Via Rosa Raimondi Garibaldi 7, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Quadrino
authors.affiliation: AOU Città della Salute e della Scienza, CPO Piemonte, Via San Francesco da Paola 31, Torino, Italy.
authors.forename: Giorgia
authors.initials: G
authors.lastname: Fiorina
authors.affiliation: AOU Città della Salute e della Scienza, CPO Piemonte, Via San Francesco da Paola 31, Torino, Italy.
authors.forename: Arianna
authors.initials: A
authors.lastname: Capuano
authors.affiliation: AOU Città della Salute e della Scienza, CPO Piemonte, Via San Francesco da Paola 31, Torino, Italy.
authors.forename: Nereo
authors.initials: N
authors.lastname: Segnan
authors.affiliation: Ospedale Fracastoro, UO Gastroenterologia, Via Circonvallazione 1, S Bonifacio, VE, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Fantin
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D015709:Correspondence as Topic; D055088:Early Detection of Cancer / Q000379:methods* / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009780:Occult Blood; D012812:Sigmoidoscopy / Q000523:psychology
keywords: CRC screening; FIT; Participation; Sigmoidoscopy