Improving uptake in non-attenders of breast screening: selective use of second appointment

To find the most cost and time effective way of increasing uptake by re-invitation of non-attenders after an initial invitation.

Women from the Warwickshire, Solihull, and Coventry breast screening programme who failed to attend their initial invitation.

Between October 1996 and February 1997, 2229 women who had failed to attend and had not declined their first invitation to screening were split into two groups according to their Sx number (a number allocated to all women when they are called for screening). Women with an odd number received a "open" invitation asking them to telephone the screening unit for another appointment and women with an even number were given a second "fixed" appointment time. The response of both groups of women was monitored.

There was a significant difference (p < 0.001) in response to a second invitation between the open invitation and fixed appointment letter (12.3% v 22.8%). The greatest disparities were between those who had attended screening in both preceding rounds and those who had failed to attend either round. Socioeconomic status measured by Townsend scores did not seem to affect the response to second appointments.

Second appointments are an important way of increasing screening uptake and thus reducing mortality, which should not be dismissed. The type of invitation is important, with fixed appointments being more effective, and the best predictor of attendance being attendance in the previous screening rounds. This information can be used to allocate resources efficiently to achieve an increased uptake.

All women should receive a second invitation, ideally as a timed appointment. However, if this appointment strategy prevents an individual screening programme maintaining a three year cycle, we have identified a group of women for whom a simple reminder letter would maintain increased uptake while allowing savings in appointment scheduling.