7. Inviting women to screening programmes
Overview
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, the ECIBC's Guidelines Development Group (GDG) suggests:
- recommends using a letter (strong recommendation, moderate certainty of the evidence)
- suggests using a letter with a fixed appointment time (conditional recommendation, moderate certainty of the evidence)
- suggests using a letter with a General Practitioner's (GP) signature (conditional recommendation, high certainty of the evidence)
- suggests using a letter followed by a phone call to remind (conditional recommendation, moderate certainty of the evidence)
- suggests using a letter followed by a written reminder (conditional recommendation, moderate certainty of the evidence)
- suggests not using a letter followed by a face to face intervention (conditional recommendation, low certainty of the evidence)
Inviting women to screening: letter followed by face to face intervention vs. letter
Issued on: May 2017
Healthcare question
Healthcare question
Should a letter followed by a face to face intervention vs. a letter alone be used for inviting asymptomatic women to organised population-based breast cancer screening programmes?
Recommendation
Recommendation
The ECIBC's Guidelines Development Group (GDG) suggests not using a letter accompanied by a face to face intervention for inviting asymptomatic women between the ages of 50 to 69 with an average risk of breast cancer (in whom screening is strongly recommended) to attend organised population-based breast cancer screening programmes.
Recommendation strength
| Conditional recommendation |
| Low certainty of the evidence |
Justification
Justification
The GDG made a conditional recommendation against the intervention. The judgement was based mainly on the imprecise estimates of the desirable effects and the large costs anticipated. The GDG did not think this intervention is feasible to implement where not already being used.
Subgroup considerations
Subgroup considerations
The GDG judged that the intervention may be feasible for specific sub-populations, particularly those in deprived areas, harder to reach using other methods.
Considerations for implementation and policy making
Considerations
- 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 the intervention not feasible to implement, given the monetary costs.
- The comparison evaluated for this recommendation needs to be interpreted in the context of the other comparisons of methods for inviting women to screening programmes evaluated by ECIBC.
- It is noted that for age groups where the recommendations made by the GDG for screening is conditional (45-49 and 70-74 age groups) informed decision-making is crucial for implementation, and there would be concern about increasing inappropriate screening with this intervention.
Research priorities
Research priorities
The GDG recommends research into doing an online interview vs. face-to-face interview.
Supporting material
yes
- Organised vs. non-organised screening
- Double vs. single reading in mammograpy screening
- Communication skills training
- Communication with care providers
- Optimal number of mammography readings
- Specialised training
- Risk stratification
- Women aged 40-44: screening vs. no screening
- Women aged 45-49: screening vs. no screening
- Women aged 45-49: annual vs. biennial screening
- Women aged 45-49: annual vs. triennial screening
- Women aged 45-49: triennial vs. biennial screening
- Women aged 50-69: screening vs. no screening
- Women aged 50-69: annual vs. biennial screening
- Women aged 50-69: annual vs. triennial screening
- Women aged 50-69: triennial vs. biennial screening
- Women aged 70-74: screening vs. no screening
- Women aged 70-74: annual vs. biennial screening
- Women aged 70-74: annual vs. triennial screening
- Women aged 70-74: triennial vs. biennial screening
- Single reading with AI support
- Double reading with AI support
- Screening with tomosynthesis vs. mammography
- Screening with tomosynthesis plus mammography vs. mammography alone
- Tailored screening with tomosynthesis
- Screening with tomosynthesis vs. mammography
- Tailored screening with MRI
- Tailored screening with ABUS
- Tailored screening with HHUS
- Informing about benefits and harms: use of decision aids
- Informing about benefits and harms: Numbers in addition to plain language
- Informing about benefits and harms: Infographics in addition to plain language
- Informing about benefits and harms: Story telling in addition to plain language
- Inviting women to screening: letter vs. no invitation
- Inviting socially disadvantaged women to screening: Targeted vs. general communication strategy
- Inviting women with an intellectual disability to screening
- Inviting non-native speakers to screening
- Inviting socially disadvantaged women to screening: Tailored vs. targeted communication strategy
- Inviting socially disadvantaged women to screening: Tailored vs. general communication strategy
- Inviting women to subsequent screening rounds: letter vs. no invitation
- Inviting women to screening: letter with fixed appointment vs. letter
- Inviting women to subsequent screening rounds: letter with fixed appointment vs. lett
- Inviting women to screening: letter with GP signature vs. letter
- Inviting women to subsequent screening rounds: letter with GP signature vs. letter
- Inviting women to screening: letter followed by phone call vs. letter
- Inviting women to subsequent screening rounds: letter followed by phone call vs. letter
- Inviting women to screening: letter followed by phone call vs. no invitation
- Inviting women to screening: letter followed by written reminder vs. letter
- Inviting women to subsequent screening rounds: letter followed by written reminder vs. letter
- Inviting women to screening: letter followed by face to face intervention vs. letter
- Inviting women to subsequent screening rounds: letter followed by face to face intervention vs. letter
- Inviting women to screening: e-mail vs. letter
- Inviting women to screening: automated telephone call vs. letter
- Inviting women to screening: letter followed by automated telephone call vs. letter
- Inviting women to screening: letter followed by SMS notification vs. letter
- Inviting women to screening: letter followed by personalised phone call vs. automated phone call
- Negative result: letter vs. nothing
- Further assessment: letter followed by a phone call
- Further assessment: timing of results
- Negative result: phone call vs. letter
- Negative result: face to face interview vs. letter
- Negative result: timing of results
- Tomosynthesis vs. assessment mammography
- Obtaining a sample from a suspicious breast lesion
- Type of guidance for needle core biopsy
- Stage 1: conventional exams
- Stage 1: PET-CT exams
- Stage 2: conventional exams
- Stage 2: PET-CT exams
- Stage 3: conventional exams
- Stage 3: PET-CT exams
- Stage 3: conventional exams plus PET-CT
- Use of clip-marking
- Additional magnetic resonance imaging
- Contrast-enhanced mammography
- Threshold of oestrogen for endocrine therapy
- Threshold of progesterone for endocrine therapy
- Multigene testing: 70 gene signature at low clinical risk
- Multigene testing: 70 gene signature at high clinical risk
- Multigene testing: 21 gene recurrence score
- Organising screening programmes
- Risk stratification
- Women 40-44
- Women 45-49
- Women 50-69
- Women 70-74
- Women with high breast density
- General Population
- Vulnerable Population
- Informing women about their results
- Women recalled due to suspicious lesions
- Obtaining a sample from a suspicious lesion
- Type of guidance for needle core biopsy
- Stage 1
- Stage 2
- Stage 3
- Planning surgical treatment
- Hormone receptor to guide use of endocrine therapy
- Multigene testing to guide use of chemotherapy