Effect of second timed appointments for non-attenders of breast cancer screening in England: a randomised controlled trial

Prue C Allgood, Roberta Maroni, Sue Hudson, Judith Offman, Anne E Turnbull, Lesley Peacock, Jim Steel, Geraldine Kirby, Christine E Ingram, Julie Somers, Clare Fuller, Anthony G. Threlfall, Rhian Gabe, Anthony J Maxwell, Julietta Patnick, Stephen W Duffy

Research output: Contribution to journalArticlepeer-review


BACKGROUND: In England, participation in breast cancer screening has been decreasing in the past 10 years, approaching the national minimum standard of 70%. Interventions aimed at improving participation need to be investigated and put into practice to stop this downward trend. We assessed the effect on participation of sending invitations for breast screening with a timed appointment to women who did not attend their first offered appointment within the NHS Breast Screening Programme (NHSBSP).

METHODS: In this open, randomised controlled trial, women in six centres in the NHSBSP in England who were invited for routine breast cancer screening were randomly assigned (1:1) to receive an invitation to a second appointment with fixed date and time (intervention) or an invitation letter with a telephone number to call to book their new screening appointment (control) in the event of non-attendance at the first offered appointment. Randomisation was by SX number, a sequential unique identifier of each woman within the NHSBSP, and at the beginning of the study a coin toss decided whether women with odd or even SX numbers would be allocated to the intervention group. Women aged 50-70 years who did not attend their first offered appointment were eligible for the analysis. The primary endpoint was participation (ie, attendance at breast cancer screening) within 90 days of the date of the first offered appointment; we used Poisson regression to compare the proportion of women who participated in screening in the study groups. All analyses were by intention to treat. This trial is registered with Barts Health, number 009304QM.

FINDINGS: We obtained 33 146 records of women invited for breast cancer screening at the six centres between June 2, 2014, and Sept 30, 2015, who did not attend their first offered appointment. 26 054 women were eligible for this analysis (12 807 in the intervention group and 13 247 in the control group). Participation within 90 days of the first offered appointment was significantly higher in the intervention group (2861 [22%] of 12 807) than in the control group (1632 [12%] of 13 247); relative risk of participation 1·81 (95% CI 1·70-1·93; p<0·0001).

INTERPRETATION: These findings show that a policy of second appointments with fixed date and time for non-attenders of breast screening is effective in improving participation. This strategy can be easily implemented by the screening sites and, if combined with simple interventions, could further increase participation and ensure an upward shift in the participation trend nationally. Whether the policy should vary by time since last attended screen will have to be considered.

FUNDING: National Health Service Cancer Screening Programmes and Department of Health Policy Research Programme.

Original languageEnglish
Pages (from-to)972-980
Number of pages9
JournalLancet oncology
Issue number7
Early online date15 May 2017
Publication statusPublished - Jul 2017

Bibliographical note

© 2017, The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license


  • Aged
  • Appointments and Schedules
  • Breast Neoplasms
  • Early Detection of Cancer
  • England
  • Female
  • Humans
  • Mammography
  • Middle Aged
  • Patient Compliance
  • Time Factors
  • Journal Article
  • Multicenter Study
  • Randomized Controlled Trial

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