Can we improve the uptake of gastroscopy in the population at risk for gastric cancer? The effect of home letter information

The poor outlook for gastric cancer in Britain is largely due to late diagn osis. Earlier diagnosis will require both easy access to endoscopy and incr eased public awareness of dyspeptic symptoms. We used information by person al letter to encourage reporting of potentially significant symptoms in pat ients over 40 years of age. The aim of this study was to measure the accept ability and effect on gastroscopy rates of home letter information. Patient s over 40 registered with 12 general practices were used in the study (prac tice population 80 000). Patients over 40 from another nine practices (prac tice population 46 500) acted as controls. A letter encouraging consultatio n for new dyspeptic symptoms was sent to all study subjects. Gastroscopy ra tes were compared in both study and control populations. Questionnaires on symptoms were sent to 500 study subjects. The principal o utcome measure was the gastroscopy rate in people over 40 in both populatio ns, before and during the intervention. The gastroscopy rate was 23% higher in the study than in the control population during the study (3.32 vs. 2.7 %, P= 0.00016, chi(2)=14.25). Gastroscopy uptake increased by 85% from 1991 /2 to 1993/4 in the study group and by 34% in the control group (chi(2)=14. 02, P= 0.00018). Thirty-one per cent of questionnaire respondents had dyspe ptic symptoms; only 3% had 'significant' symptoms of between 2 and 52 weeks duration. Home letters are an acceptable and efficient method of increasin g gastroscopy uptake in dyspeptic patients over 40.