Effect of second timed appointments for non-attenders of breast cancer screening in England: a randomised controlled trial

Prue C Allgood; Roberta Maroni; Sue Hudson; Judith Offman; Anne E Turnbull; Lesley Peacock; Jim Steel; Geraldine Kirby; Christine E Ingram; Julie Somers; Clare Fuller; Anthony G Threlfall; Rhian Gabe; Anthony J Maxwell; Julietta Patnick; Stephen W Duffy

doi:10.1016/S1470-2045(17)30340-6

Effect of second timed appointments for non-attenders of breast cancer screening in England: a randomised controlled trial

Prue C Allgood
, Roberta Maroni
, Sue Hudson
, Judith Offman
, Anne E Turnbull
, Lesley Peacock
, Jim Steel
, Geraldine Kirby
, Christine E Ingram
, Julie Somers
, Clare Fuller
, Anthony G Threlfall
, Rhian Gabe
, Anthony J Maxwell
, Julietta Patnick
, Stephen W Duffy

Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK.
Peel and Schriek Consulting, London, UK.
Derby Teaching Hospitals NHS Foundation Trust
Hull and East Yorkshire Hospitals NHS Trust
Plymouth Hospitals NHS Trust, Derriford Hospital, Primrose Breast Care Centre, Plymouth, UK.
King's College Hospital
Sheffield Teaching Hospitals NHS Foundation Trust
Imperial College London
Theorize, Manchester, UK.
University of York
Division of Informatics, Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Nightingale Centre, University Hospital of South Manchester, Manchester, UK.
Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK. Electronic address: [email protected].
University of Oxford

Research output: Contribution to journal › Article › peer-review

30 Citations (Scopus)

Abstract

BACKGROUND: In England, participation in breast cancer screening has been decreasing in the past 10 years, approaching the national minimum standard of 70%. Interventions aimed at improving participation need to be investigated and put into practice to stop this downward trend. We assessed the effect on participation of sending invitations for breast screening with a timed appointment to women who did not attend their first offered appointment within the NHS Breast Screening Programme (NHSBSP).

METHODS: In this open, randomised controlled trial, women in six centres in the NHSBSP in England who were invited for routine breast cancer screening were randomly assigned (1:1) to receive an invitation to a second appointment with fixed date and time (intervention) or an invitation letter with a telephone number to call to book their new screening appointment (control) in the event of non-attendance at the first offered appointment. Randomisation was by SX number, a sequential unique identifier of each woman within the NHSBSP, and at the beginning of the study a coin toss decided whether women with odd or even SX numbers would be allocated to the intervention group. Women aged 50-70 years who did not attend their first offered appointment were eligible for the analysis. The primary endpoint was participation (ie, attendance at breast cancer screening) within 90 days of the date of the first offered appointment; we used Poisson regression to compare the proportion of women who participated in screening in the study groups. All analyses were by intention to treat. This trial is registered with Barts Health, number 009304QM.

FINDINGS: We obtained 33 146 records of women invited for breast cancer screening at the six centres between June 2, 2014, and Sept 30, 2015, who did not attend their first offered appointment. 26 054 women were eligible for this analysis (12 807 in the intervention group and 13 247 in the control group). Participation within 90 days of the first offered appointment was significantly higher in the intervention group (2861 [22%] of 12 807) than in the control group (1632 [12%] of 13 247); relative risk of participation 1·81 (95% CI 1·70-1·93; p<0·0001).

INTERPRETATION: 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.

FUNDING: National Health Service Cancer Screening Programmes and Department of Health Policy Research Programme.

Original language	English
Pages (from-to)	972-980
Number of pages	9
Journal	The Lancet Oncology
Volume	18
Issue number	7
DOIs	https://doi.org/10.1016/S1470-2045(17)30340-6
Publication status	Published - Jul 2017

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

Aged
Appointments and Schedules
Breast Neoplasms/diagnostic imaging
Early Detection of Cancer
England
Female
Humans
Mammography
Middle Aged
Patient Compliance/statistics & numerical data
Time Factors

Access to Document

10.1016/S1470-2045(17)30340-6

Cite this

Allgood, P. C., Maroni, R., Hudson, S., Offman, J., Turnbull, A. E., Peacock, L., Steel, J., Kirby, G., Ingram, C. E., Somers, J., Fuller, C., Threlfall, A. G., Gabe, R., Maxwell, A. J., Patnick, J., & Duffy, S. W. (2017). Effect of second timed appointments for non-attenders of breast cancer screening in England: a randomised controlled trial. The Lancet Oncology, 18(7), 972-980. https://doi.org/10.1016/S1470-2045(17)30340-6

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title = "Effect of second timed appointments for non-attenders of breast cancer screening in England: a randomised controlled trial",

abstract = "BACKGROUND: In England, participation in breast cancer screening has been decreasing in the past 10 years, approaching the national minimum standard of 70\%. Interventions aimed at improving participation need to be investigated and put into practice to stop this downward trend. We assessed the effect on participation of sending invitations for breast screening with a timed appointment to women who did not attend their first offered appointment within the NHS Breast Screening Programme (NHSBSP).METHODS: In this open, randomised controlled trial, women in six centres in the NHSBSP in England who were invited for routine breast cancer screening were randomly assigned (1:1) to receive an invitation to a second appointment with fixed date and time (intervention) or an invitation letter with a telephone number to call to book their new screening appointment (control) in the event of non-attendance at the first offered appointment. Randomisation was by SX number, a sequential unique identifier of each woman within the NHSBSP, and at the beginning of the study a coin toss decided whether women with odd or even SX numbers would be allocated to the intervention group. Women aged 50-70 years who did not attend their first offered appointment were eligible for the analysis. The primary endpoint was participation (ie, attendance at breast cancer screening) within 90 days of the date of the first offered appointment; we used Poisson regression to compare the proportion of women who participated in screening in the study groups. All analyses were by intention to treat. This trial is registered with Barts Health, number 009304QM.FINDINGS: We obtained 33 146 records of women invited for breast cancer screening at the six centres between June 2, 2014, and Sept 30, 2015, who did not attend their first offered appointment. 26 054 women were eligible for this analysis (12 807 in the intervention group and 13 247 in the control group). Participation within 90 days of the first offered appointment was significantly higher in the intervention group (2861 [22\%] of 12 807) than in the control group (1632 [12\%] of 13 247); relative risk of participation 1·81 (95\% CI 1·70-1·93; p<0·0001).INTERPRETATION: 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.FUNDING: National Health Service Cancer Screening Programmes and Department of Health Policy Research Programme.",

keywords = "Aged, Appointments and Schedules, Breast Neoplasms/diagnostic imaging, Early Detection of Cancer, England, Female, Humans, Mammography, Middle Aged, Patient Compliance/statistics \& numerical data, Time Factors",

author = "Allgood, \{Prue C\} and Roberta Maroni and Sue Hudson and Judith Offman and Turnbull, \{Anne E\} and Lesley Peacock and Jim Steel and Geraldine Kirby and Ingram, \{Christine E\} and Julie Somers and Clare Fuller and Threlfall, \{Anthony G\} and Rhian Gabe and Maxwell, \{Anthony J\} and Julietta Patnick and Duffy, \{Stephen W\}",

year = "2017",

month = jul,

doi = "10.1016/S1470-2045(17)30340-6",

language = "English",

volume = "18",

pages = "972--980",

journal = "The Lancet Oncology",

issn = "1470-2045",

publisher = "Elsevier Limited",

number = "7",

}

Allgood, PC, Maroni, R, Hudson, S, Offman, J, Turnbull, AE, Peacock, L, Steel, J, Kirby, G, Ingram, CE, Somers, J, Fuller, C, Threlfall, AG, Gabe, R, Maxwell, AJ, Patnick, J & Duffy, SW 2017, 'Effect of second timed appointments for non-attenders of breast cancer screening in England: a randomised controlled trial', The Lancet Oncology, vol. 18, no. 7, pp. 972-980. https://doi.org/10.1016/S1470-2045(17)30340-6

TY - JOUR

T1 - Effect of second timed appointments for non-attenders of breast cancer screening in England

T2 - a randomised controlled trial

AU - Allgood, Prue C

AU - Maroni, Roberta

AU - Hudson, Sue

AU - Offman, Judith

AU - Turnbull, Anne E

AU - Peacock, Lesley

AU - Steel, Jim

AU - Kirby, Geraldine

AU - Ingram, Christine E

AU - Somers, Julie

AU - Fuller, Clare

AU - Threlfall, Anthony G

AU - Gabe, Rhian

AU - Maxwell, Anthony J

AU - Patnick, Julietta

AU - Duffy, Stephen W

PY - 2017/7

Y1 - 2017/7

N2 - BACKGROUND: In England, participation in breast cancer screening has been decreasing in the past 10 years, approaching the national minimum standard of 70%. Interventions aimed at improving participation need to be investigated and put into practice to stop this downward trend. We assessed the effect on participation of sending invitations for breast screening with a timed appointment to women who did not attend their first offered appointment within the NHS Breast Screening Programme (NHSBSP).METHODS: In this open, randomised controlled trial, women in six centres in the NHSBSP in England who were invited for routine breast cancer screening were randomly assigned (1:1) to receive an invitation to a second appointment with fixed date and time (intervention) or an invitation letter with a telephone number to call to book their new screening appointment (control) in the event of non-attendance at the first offered appointment. Randomisation was by SX number, a sequential unique identifier of each woman within the NHSBSP, and at the beginning of the study a coin toss decided whether women with odd or even SX numbers would be allocated to the intervention group. Women aged 50-70 years who did not attend their first offered appointment were eligible for the analysis. The primary endpoint was participation (ie, attendance at breast cancer screening) within 90 days of the date of the first offered appointment; we used Poisson regression to compare the proportion of women who participated in screening in the study groups. All analyses were by intention to treat. This trial is registered with Barts Health, number 009304QM.FINDINGS: We obtained 33 146 records of women invited for breast cancer screening at the six centres between June 2, 2014, and Sept 30, 2015, who did not attend their first offered appointment. 26 054 women were eligible for this analysis (12 807 in the intervention group and 13 247 in the control group). Participation within 90 days of the first offered appointment was significantly higher in the intervention group (2861 [22%] of 12 807) than in the control group (1632 [12%] of 13 247); relative risk of participation 1·81 (95% CI 1·70-1·93; p<0·0001).INTERPRETATION: 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.FUNDING: National Health Service Cancer Screening Programmes and Department of Health Policy Research Programme.

AB - BACKGROUND: In England, participation in breast cancer screening has been decreasing in the past 10 years, approaching the national minimum standard of 70%. Interventions aimed at improving participation need to be investigated and put into practice to stop this downward trend. We assessed the effect on participation of sending invitations for breast screening with a timed appointment to women who did not attend their first offered appointment within the NHS Breast Screening Programme (NHSBSP).METHODS: In this open, randomised controlled trial, women in six centres in the NHSBSP in England who were invited for routine breast cancer screening were randomly assigned (1:1) to receive an invitation to a second appointment with fixed date and time (intervention) or an invitation letter with a telephone number to call to book their new screening appointment (control) in the event of non-attendance at the first offered appointment. Randomisation was by SX number, a sequential unique identifier of each woman within the NHSBSP, and at the beginning of the study a coin toss decided whether women with odd or even SX numbers would be allocated to the intervention group. Women aged 50-70 years who did not attend their first offered appointment were eligible for the analysis. The primary endpoint was participation (ie, attendance at breast cancer screening) within 90 days of the date of the first offered appointment; we used Poisson regression to compare the proportion of women who participated in screening in the study groups. All analyses were by intention to treat. This trial is registered with Barts Health, number 009304QM.FINDINGS: We obtained 33 146 records of women invited for breast cancer screening at the six centres between June 2, 2014, and Sept 30, 2015, who did not attend their first offered appointment. 26 054 women were eligible for this analysis (12 807 in the intervention group and 13 247 in the control group). Participation within 90 days of the first offered appointment was significantly higher in the intervention group (2861 [22%] of 12 807) than in the control group (1632 [12%] of 13 247); relative risk of participation 1·81 (95% CI 1·70-1·93; p<0·0001).INTERPRETATION: 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.FUNDING: National Health Service Cancer Screening Programmes and Department of Health Policy Research Programme.

KW - Aged

KW - Appointments and Schedules

KW - Breast Neoplasms/diagnostic imaging

KW - Early Detection of Cancer

KW - England

KW - Female

KW - Humans

KW - Mammography

KW - Middle Aged

KW - Patient Compliance/statistics & numerical data

KW - Time Factors

U2 - 10.1016/S1470-2045(17)30340-6

DO - 10.1016/S1470-2045(17)30340-6

M3 - Article

C2 - 28522311

SN - 1470-2045

VL - 18

SP - 972

EP - 980

JO - The Lancet Oncology

JF - The Lancet Oncology

IS - 7

ER -

Effect of second timed appointments for non-attenders of breast cancer screening in England: a randomised controlled trial

Abstract

UN SDGs

Keywords

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