Should a letter followed by a phone call to remind vs. no invitation to organised screening be used for inviting asymptomatic women to organised population-based breast cancer screening programmes?

The GDG noted that this comparison should be interpreted in the context of the other comparisons related to methods used to invite women to organised screening programmes.

The GDG noted that for women between the ages of 50 and 69, in whom screening is strongly recommended, the balance would favour the intervention because participation rate is an appropriate outcome. Participation rate was not considered an appropriate outcome for the other age ranges. For women in the age groups, 45-49 and 70-74, outcomes such as confidence and satisfaction of the woman in making an informed decision are crucial and the GDG advises interpretation of this intervention in the context of the recommendations on screening age ranges (please see point 4 in the implementation considerations).

• 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 recommendation 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. Where the GDG made a strong recommendation for screening in women between the ages of 50 and 69, this intervention is recommended as this intervention is desirable to increase participation in screening.
• Due to the large costs associated with this intervention, the GDG felt that this intervention was not feasible to implement in some countries.
• The GDG noted that implementation will have to consider access to cell phones or land lines for women to receive reminder calls and whether laws limiting access to and use of phone numbers for contacting women are applicable in this specific context.

The GDG noted that the more important research priority is the question comparing a letter plus a phone call vs. a letter alone, as this is the comparison that is common practice in most countries.