Repeat invitations and participation in cervical screening: A population-based cohort study

Area of Science:

• Public Health
• Epidemiology
• Health Services Research

Background:

• Cervical cancer screening participation is vital for reducing disease incidence and mortality.
• Optimizing the timing of repeated invitation (RI) letters is a key strategy to improve screening uptake among non-attendees.

Purpose of the Study:

• To determine the optimal time interval for sending repeated invitation (RI) letters to enhance cervical cancer screening participation.
• To analyze the association between RI timing and participation rates across different age groups.

Main Methods:

• A prospective, population-based cohort study involving over 3.3 million first invitations and 2.4 million RIs in Sweden (2012-2023).
• Analysis of participation rates based on the time between the initial invitation and the first RI, adjusted for demographic and clinical factors.
• Evaluation of participation trends with increasing numbers of RIs sent.

Main Results:

• The highest participation rate (65%) was observed when RIs were sent 8-12 weeks after the initial invitation, showing an adjusted odds ratio (aOR) of 1.42.
• This optimal timing demonstrated consistent effectiveness across women under 50 (aOR 1.35) and over 50 (aOR 1.95).
• Participation decreased with subsequent RIs, with only 10.9% requiring four or more RIs.

Conclusions:

• Sending a repeated invitation for cervical cancer screening 8-12 weeks post-initial invitation is the most effective strategy for increasing participation.
• Strategies beyond four RIs may be necessary, as participation wanes with repeated mailings.
• Optimizing RI timing can improve screening coverage and contribute to cervical cancer prevention efforts.