7. Inviting and informing women about screening
7.1 Inviting general population to screening
Recommendations
How should you expect to be invited to an organised mammography screening programme?
With a letter, as recommended by the ECIBC's Guidelines Development Group (GDG).
The GDG also suggests using a decision aid that explains the benefits and harms of screening.
What could be included in the invitation letter?
The GDG suggests that the letter can include:
- a general practitioner's (GP) signature
- a fixed appointment.
Should you expect to be reminded about the invitation?
Yes, the GDG suggests following the invitation letter with either,
- a written reminder,
- an SMS, or
- an automated phone call.
How else could you be invited?
With an email or an automated phone call, if the previous strategies are not available.
Who are these recommendations for?
- You are between 50 and 69 years old
- You do not have a high risk of breast cancer
- You do not have symptoms of breast cancer
Additional considerations
For women aged 50-69, screening is strongly recommended and invitation letters probably increase their participation. The GDG judged that the benefits of the increase in participation compensate for the additional costs of producing and sending the letters in this age group. Invitation emails and automated phone calls may also slightly increase women’s participation in screening programmes and might reduce the cost of invitation.
However, the GDG noted that there could be higher costs from using a fixed appointment, a face-to-face meeting, and a phone (call or SMS) or written reminder. Some women may feel disturbed or pressured when receiving a reminder or a letter with a GP’s signature, if they have already made an informed decision not to attend screening; and some women may find face to face meetings very intrusive.
Looking at the evidence available, the GDG judged that decision aids are likely to increase women's knowledge of the benefits and harms of screening and thus increase their confidence in making informed decisions concerning participation in screening. Some examples of decision aids are included in the definition. Although the GDG does not support any specific decision aid included in the reviewed evidence, it considers that decision aids should be evidence-based and appropriate to the context of their use.
The GDG did not formulate recommendations on how to invite women aged 45-49 and 70-74, for whom attending screening is, however, suggested. If you are in one of these age ranges and receive an invitation, you can speak with your healthcare professional about the benefits and harms of attending screening.
Definitions
High risk of breast cancer refers to women with increased risk due to genetic predisposition (mutations in BRCA1 and BRCA2), reproductive history or race and ethnicity.
Decision aids are defined by the International Patient Decision Aids Standards (IPDAS). Collaboration as evidence-based tools designed to help patients (women in the case of screening) participate in making specific and deliberated choices among different healthcare options (Elwyn G, 2006). Some examples of decision aids included in the evidence reviewed by the GDG are:
- Printed materials describing a health condition and the risks associated with it, providing benefits and harms according to women’s screening choices.
- A webpage with diagrams and texts describing outcomes of screening and chances of those outcomes occurring, allowing the woman to integrate her personal beliefs and preferences.
7.2 Inviting vulnerable population to screening
Recommendations
How should women from socially disadvantaged groups, with an intellectual disability or non-native speakers expect to be invited to breast cancer screening programmes?
- With a targeted communication strategy, as suggested by the ECIBC's Guidelines Development Group (GDG)
- With some tailored communication strategies for inviting women from socially disadvantaged groups.
Who are these recommendations for?
- Women from socially disadvantaged groups, or
- women with an intellectual disability, or
- non-native speakers
who,
- are between 50 and 69 years old
- do not have a high risk of breast cancer
- do not have symptoms of breast cancer
Additional considerations
For women aged 50-69 screening is strongly recommended, and invitations targeted at women from specific vulnerable populations may increase their participation in screening programmes.
The GDG noted that different tailored interventions may have different effects in women from socially disadvantaged groups participating in screening programmes. Some tailored invitation letters including individualised risk factor information probably reduce women’s participation; whereas other strategies tailored to women’s knowledge about breast cancer and screening may increase their participation, but the evidence is very uncertain.
The GDG did not formulate recommendations on how to invite women aged 45-49 and 70-74, for whom attending screening is, however, suggested.
If you are in one of these age ranges and receive an invitation, you can speak with your healthcare professional about the benefits and harms of attending screening.
Definitions
High risk of breast cancer refers to women with increased risk due to genetic predisposition (mutations in BRCA1 and BRCA2), reproductive history or race and ethnicity.
Targeted communication strategy: According to the evidence reviewed by the GDG, targeting refers to any intervention for a defined sub-population that takes into account characteristics shared by the sub-population’s members. Some of the interventions included in the evidence involved telephone counselling in addition to educational material, a comprehensive health assessment programme, or telephone reminders followed by telephone support, among others.
Tailored communication strategy: According to the evidence reviewed by the GDG, tailoring refers to any individualised intervention for women with the expectation that it will lead to an increase in participation in screening. Some of the interventions included in the evidence involved interactive computer programmes or personalised letters.