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A randomized controlled trial comparing three invitation strategies in a breast cancer screening program
J M Segura1, X Castells, M Casamitjana
1CAP Dr. Sayé, Institut Català de la Salut, Barcelona, Spain.
Preventive Medicine
|September 26, 2001
Summary
Directly inviting women to breast cancer screening programs significantly boosts participation, especially for those with lower education levels, compared to standard mailings. This highlights effective strategies for public health outreach.
Area of Science:
- Public Health
- Epidemiology
- Health Services Research
Background:
- Population-based breast cancer screening programs aim to reduce mortality through early detection.
- Invitation strategies significantly influence program uptake and effectiveness.
- Comparing different outreach methods is crucial for optimizing screening program participation.
Purpose of the Study:
- To compare the effectiveness of three invitation strategies for a breast cancer screening program: program-mailed letters, Primary Health Care Team (PHT)-mailed letters, and direct contact by trained personnel.
- To determine which invitation method yields the highest response rate in a population-based screening program.
- To identify demographic factors, such as educational level, that may influence response rates across different invitation strategies.
Main Methods:
- A cluster-randomized controlled trial was conducted involving 986 women aged 50-64 in Barcelona, Spain.
- Participants were assigned to invitation groups based on home address: program group, PHT group, or direct contact group.
- The primary outcome measured was the response rate following the initial invitation.
Main Results:
- Overall, 57.2% of women invited participated in the screening program.
- The direct contact group achieved the highest response rate (63.5%), followed by the PHT group (55.6%), and the program group (52.1%).
- Direct contact significantly increased participation probability compared to both PHT (RR=1.14, P=0.037) and program groups (RR=1.22, P=0.003), with a notable effect among women receiving the invitation directly and those of lower educational levels.
Conclusions:
- Direct contact by trained personnel is a more effective strategy for increasing participation in breast cancer screening programs than traditional mailed invitations.
- The enhanced participation observed with direct contact was particularly pronounced among women with lower educational attainment.
- These findings suggest that tailored, personal outreach methods can improve the reach of public health screening initiatives, especially for potentially underserved populations.