Impact of Follow up Letters on Non-Attenders for Breast Screening: A General Practice Based Study

Objective— To determine the effectiveness of follow up letters to non-attenders for screening on the breast screening uptake in practices with a low preliminary uptake of screening. Design— Observational study of two groups of general practices. In 40 of these practices, the preliminary uptake of screening was less than 60%These 40 practices were offered help from a clerical officer to check names and addresses of non-attenders, and to send non-attenders a reminder letter. Setting— 93 general practices in South West London in 1995–96. Main outcome measures— Preliminary and final uptake of breast screening. Results— Breast screening uptake increased by an average of 4.6% in the 40 intervention practices compared with 1.6% in the 53 control practices (difference 3.0%, P < 0.0001). However, the absolute increase in the uptake of screening in the intervention group was small (from 53.8% to 58.5%). The marginal cost for each additional women screened was £7 (compared with an average cost for each women screened of £27). Conclusions— Reminder letters can help increase the uptake of screening in practices with a low preliminary uptake of breast screening. However, they have a limited role in improving the uptake of breast screening in inner city areas, and other methods of increasing uptake therefore need to be developed and evaluated.