IMPROVING UPTAKE IN NONATTENDERS OF BREAST SCREENING - SELECTIVE USE OF 2ND APPOINTMENT

Objective-To find the most cost and time effective way of increasing u ptake by reinvitation of non-attenders after an initial invitation. Se tting-Women from the Warwickshire, Solihull, and Coventry breast scree ning programme who failed to attend their initial invitation. Method-B etween October 1996 and February 1997, 2229 women who had failed to at tend and had not declined their first invitation to screening were spl it into two groups according to their Sr number (a number allocated to all women when they are called for screening). Women with an odd numb er received a ''open'' invitation asking them to telephone the screeni ng unit for another appointment and women with an even number were giv en a second ((fixed)) appointment time. The response of both groups of women was monitored. Results-There was a significant difference (p<0. 001) in response to a second invitation between the open invitation an d fixed appointment letter (12.3% v 22.8%). The greatest disparities w ere 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 sec ond appointments. Conclusion-Second appointments are an important way of increasing screening uptake and thus reducing mortality, which shou ld not be dismissed. The type of invitation is important, with fixed a ppointments being more effective, and the best predictor of attendance being attendance in the previous screening rounds. This information c an be used to allocate resources efficiently to achieve an increased u ptake. Recommendations-Ah women should receive a second invitation, id eally as a timed appointment. However, if this appointment strategy pr events an individual screening programme maintaining a three year cycl e, we have identified a group of women for whom a simple reminder lett er would maintain increased uptake while allowing savings in appointme nt scheduling.