title: Invitation to cervical cancer screening does increase participation in Germany: Results from the MARZY study.
abstract: The effect of different invitation models on participation in cervical cancer screening (CCS) was investigated in a randomized population-based cohort study in Germany. Participants were randomly selected via population registries and randomized into intervention Arm A (invitation letter) and Arm B (invitation letter and information brochure) or control Arm C (no invitation). The intervention and control arms were compared with regard to 3-year participation and the two invitation models were compared between intervention arms. Of the 7,758 eligible women aged 30-65 years, living in the city of Mainz and in the rural region of Mainz-Bingen, 5,265 were included in the analysis. Differences in proportions of women attending CCS were investigated and logistic regression was performed to analyze various factors influencing participation. In the intervention group, 91.8% participated in CCS compared to 85.3% in the control group (p < 0.0001), with a 6.6 percentage point increase in participation [95% confidence interval (CI) 4.6-8.6] and an adjusted odds ratio (OR) of 2.69 (95% CI 2.15-3.37). Effect estimators increased to 21.9 percentage points (95% CI 16.7-27.1) and an OR of 3.64 (95% CI 2.74-4.82), respectively, when women who participated in screening annually were excluded from the analysis. The invitation letter was particularly effective among women with lower school education, migrant women and older women. No difference in participation was found between the intervention Arm A and Arm B. An accompanying information brochure did not motivate more women to undergo CCS. However, a written invitation statistically significantly increased participation in CCS in Germany.
authors.affiliation: Cancer Epidemiology, University Cancer Center, University Hospital, Technische Universität Dresden, Dresden, Germany.
authors.forename: Kathrin
authors.initials: K
authors.lastname: Radde
authors.affiliation: Cancer Epidemiology, University Cancer Center, University Hospital, Technische Universität Dresden, Dresden, Germany.
authors.forename: Andrea
authors.initials: A
authors.lastname: Gottschalk
authors.affiliation: Division of Preventive Oncology, National Center for Tumor Diseases and German Cancer Research Center, Heidelberg, Germany.
authors.forename: Ulrike
authors.initials: U
authors.lastname: Bussas
authors.affiliation: Cancer Epidemiology, University Cancer Center, University Hospital, Technische Universität Dresden, Dresden, Germany.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Schülein
authors.affiliation: Cancer Epidemiology, University Cancer Center, University Hospital, Technische Universität Dresden, Dresden, Germany.
authors.forename: Dirk
authors.initials: D
authors.lastname: Schriefer
authors.affiliation: Cancer Epidemiology, University Cancer Center, University Hospital, Technische Universität Dresden, Dresden, Germany.
authors.forename: Ulrike
authors.initials: U
authors.lastname: Seifert
authors.affiliation: Cancer Epidemiology, University Cancer Center, University Hospital, Technische Universität Dresden, Dresden, Germany.
authors.forename: Anne
authors.initials: A
authors.lastname: Neumann
authors.affiliation: Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany.
authors.forename: Melanie
authors.initials: M
authors.lastname: Kaiser
authors.affiliation: Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany.
authors.forename: Maria
authors.initials: M
authors.lastname: Blettner
authors.affiliation: Cancer Epidemiology, University Cancer Center, University Hospital, Technische Universität Dresden, Dresden, Germany.
authors.forename: Stefanie J
authors.initials: SJ
authors.lastname: Klug
mesh_terms: D000328:Adult; D000368:Aged; D055088:Early Detection of Cancer; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008403:Mass Screening; D008875:Middle Aged; D016017:Odds Ratio; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011159:Population Surveillance; D012042:Registries; D012307:Risk Factors; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000453:epidemiology*
keywords: early detection of cancer; invitation letter; participation; randomized cohort study; uterine cervical neoplasm