A randomized controlled trial comparing three invitation strategies in a breast cancer screening program

Prev Med. 2001 Oct;33(4):325-32. doi: 10.1006/pmed.2001.0891.


Background: The objective of this study was to compare the response received by a population-based breast cancer screening program, according to three different invitation strategies: letters sent by mail from the program (program group), letters sent by mail from the Primary Health Care Team (PHT group), and direct contact through a trained professional (direct contact group).

Methods: We used a cluster-randomized controlled trial with assignment to invitation group using home address. Nine hundred eighty-six women of Barcelona (Spain), ages 50 to 64 years, were invited to participate in the program. The main outcome used was the response rate after the first invitation.

Results: Five hundred sixty-four women accepted the invitation (57.2%). The highest response rate was achieved in the direct contact group (63.5%), followed by the PHT group (55.6%), the program group being the one that attained the lowest response rate (52.1%). The direct contact group had a higher probability of participating than the PHT group (RR = 1.14, P = 0.037) or the program group (RR = 1.22, P = 0.003). The response rate in the direct contact group was 72.1% when the letter was received by the subject herself. The increase in response occurred particularly among women of lower educational level.

Conclusions: Inviting women to participate in a breast cancer screening program through direct contact by trained personnel increased participation rate compared with mailed-letter methods. The positive effect appeared restricted to women with lower educational levels.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Breast Neoplasms / prevention & control*
  • Education
  • Female
  • Humans
  • Logistic Models
  • Mammography / statistics & numerical data*
  • Marketing of Health Services / methods*
  • Middle Aged
  • Patient Acceptance of Health Care / statistics & numerical data*
  • Persuasive Communication*
  • Postal Service
  • Poverty Areas
  • Professional-Patient Relations
  • Risk
  • Spain