A randomized controlled trial comparing three invitation strategies in a breast cancer screening program

Background. The objective of this study was to compare the response receive d by a population-based breast cancer screening program, according to three different invitation strategies: letters sent by mail from the program (pr ogram group), letters sent by mail from the Primary Health Care Team (PHT g roup), and direct contact through a trained professional (direct contact gr oup). Methods. We used a cluster-randomized controlled trial with assignment to i nvitation group using home address. Nine hundred eighty-six women of Barcel ona (Spain), ages 50 to 64 years, were invited to participate in the progra m. The main outcome used was the response rate after the first invitation. Results. Five hundred sixty-four women accepted the invitation (57.2%). The highest response rate was achieved in the direct contact group (63.5%), fo llowed by the PHT group (55.6%), the program group being the one that attai ned the lowest response rate (52.1%). The direct contact group had a higher probability of participating than the PHT group (RR = 1.14, P = 0.037) or the program group (RR = 1.22, P = 0.003). The response rate in the direct c ontact group was 72.1% when the letter was received by the subject herself. The increase in response occurred particularly among women of lower educat ional level. Conclusions. Inviting women to participate in a breast cancer screening pro gram through direct con.. tact by trained personnel increased participation rate compared with mailed-letter methods. The positive effect appeared res tricted to women with lower educational levels. (C) 2001 American Health Fo undation and Academic Press.