Recommendations from European Breast Guidelines

What is the optimal strategy to invite women to organised breast cancer screening programmes?

For cancer screening programmes to bring about reductions in breast cancer mortality, a substantial proportion of the population must participate. Programmes with low uptake can be ineffective and can promote inequalities in health-services. For these reasons, the participation rate is a key parameter to assess both the impact of the screening programme and its acceptability among the target population. These recommendations aim to determine the best strategies to invite women to organised breast cancer screening programmes.


Recommendations

The ECIBC's Guidelines Development Group recommends using a letter for inviting asymptomatic women aged 50 to 69 with an average risk of breast cancer (in whom screening is strongly recommended) to attend organised population-based screening programmes (strong recommendation, moderate certainty evidence).
The ECIBC's Guidelines Development Group suggests using either a letter with a General Practitioner┬┤s (GP) signature, a letter with a fixed appointment, a letter followed by a phone reminder or a letter followed by a written reminder over letters alone, for inviting asymptomatic women aged 50 to 69 with an average risk of breast cancer (in whom screening is strongly recommended) to attend organised population-based screening programmes (conditional recommendation, moderate certainty evidence).
The ECIBC's Guidelines Development Group suggests against using a letter accompanied by a face to face intervention, for inviting asymptomatic women aged 50 to 69 with an average risk of breast cancer (in whom screening is strongly recommended) to attend organised population-based screening programmes (conditional recommendation, low certainty evidence).

Summary of Judgements

  letters
vs.
no invitation to organised screening
letters plus fixed appointments
vs.
letters
letters plus GP signature
vs.
letters
letters plus phone call to remind
vs.
letters
letters plus phone call to remind
vs.
no invitation to organised screening
letters plus a written reminder
vs.
letters alone
letters plus a face to face interview
vs.
letters alone
Certainty of evidence Moderate Moderate High Moderate Moderate Moderate Low
Balance of effects Favors the intervention Probably favors the intervention Probably favors the intervention Probably favors the intervention Probably favors the intervention Probably favors the intervention Probably favors the intervention
Resources required Moderate costs Moderate costs Negligible costs and savings Varies Large costs Moderate costs Large costs
Cost effectiveness No included studies No included studies No included studies No included studies No included studies No included studies No included studies
Equity Probably increased Varies Varies Probably increased Probably increased Probably increased Probably increased
Acceptability Probably yes Varies Varies Varies Varies Probably yes Varies
Feasibility Yes Probably yes Varies Varies Varies Probably yes No