Effect of Fixed Second Appointments on Breast Cancer Screening Attendance
In a UK study reported in The Lancet Oncology, Allgood et al found that provision of a second timed appointment for breast cancer screening improved screening rates among women who did not attend a first offered appointment.
Study Details
In the study, women who were invited for breast screening at six National Health Service Breast Screening Programme centers between June 2014 and September 2015 were randomized to receive an invitation to a second appointment with a fixed date and time within 90 days of the initial appointment (intervention group) or an invitation letter with a telephone number to call to book a new screening appointment if they failed to attend the initial appointment. A total of 26,054 women aged 50 to 70 years did not attend the initial appointment, including 12,807 in the intervention group and 13,247 in the control group. The primary endpoint was attendance at breast cancer screening within 90 days of the date of the first appointment.
Effect on Attendance
The rate of attendance within 90 days of the first appointment was 22% in the intervention group vs 12% of the control group (relative risk = 1.81, P < .0001). Among the 49% of women being invited for a prevalence screening round, attendance rates were 17% vs 7% among those aged 50 to 52 years (P < .0001) and 7% vs 2% among those aged 53 to 70 years (P < .0001).
Attendance rates were 34% vs 21% (P < .0001) among women who had attended screening at any time in the past, 46% vs 29% among those aged 51 to 70 years who had attended screening 1 to < 3 years previously (P < .0001), 35% vs 19% among those aged 53 to 70 years who had attended screening 3 to < 6 years previously, 13% vs 7% among those aged 56 to 70 years who had attended screening 6 to < 9 years previously (P < .0001), and 7% vs 4% among those aged 59 to 70 years who had attended screening > 9 years previously.
The investigators concluded: “These findings show that a policy of second appointments with fixed date and time for non-attenders of breast screening is effective in improving participation. This strategy can be easily implemented by the screening sites and, if combined with simple interventions, could further increase participation and ensure an upward shift in the participation trend nationally. Whether the policy should vary by time since last attended screen will have to be considered.”
The study was funded by the National Health Service Cancer Screening Programmes and Department of Health Policy Research Programme.
Stephen W. Duffy, MSc, of the Centre for Cancer Prevention, Queen Mary University of London, is the corresponding author of The Lancet Oncology article.
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