European guidelines on breast cancer screening and diagnosis

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.

• 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

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.

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.