Should a letter followed by a face to face intervention vs. a letter alone be used for inviting women to subsequent breast cancer screening rounds?

The GDG made a conditional recommendation against the intervention and the judgement was based mainly on the imprecise estimates of the desirable effects and the large costs that were anticipated. The GDG did not think this intervention was feasible to implement in jurisdictions where it is not already being used.

The GDG noted that for the subgroup of women who had a false positive results in the previous screening round the intervention may be feasible and the cost are decreased (moderate) because of the smaller number of women involved. Moreover in this subgroup it is expected to have a larger effect (due to probably higher prevalence).

For these reasons the GDG suggests for inviting women who had a false positive result in the previous screening round to the subsequent ones using a letter followed by a face to face interviention (conditional recommendation, low certainty of the evidence).

• The comparison evaluated for this recommendation needs to be interpreted in the context of the other comparisons on methods for inviting women to screening programmes evaluated by ECIBC.
• The GDG was not aware of any countries currently using face-to-face invitation in addition to letters for invitation to screening programmes.
• The GDG judged that the intervention was not feasible to implement, given the monetary costs. For the subgroup of women who tested false positive in a previous screening round the intervention should be more feasible and the costs should be lower due to the smaller number of women involved.
• Most of the EU programmes involved in a survey about the way of communicating results of breast cancer screening reported that they do not differentiate between women who tested negative in the previous screening round and women who were false positive. Women are invited in the same way with identical invitation letters.