A telephone reminder intervention to improve breast screening information and access.

OBJECTIVES: In the UK, women aged 50-70 are offered breast cancer screening every three years. Screening participation rates in London have been particularly low. Low rates have been associated with low socio-economic status, and some ethnic groups have been observed to be underserved by cancer screening. This paper reports on a telephone reminder intervention in London Newham, an area of high deprivation and ethnic diversity. STUDY DESIGN: Observational study of planned intervention. METHODS: Women invited for breast screening were telephoned to confirm receipt of the invitation letter, remind invitees of their upcoming appointment, and to provide further information. Aggregate data at general practice level on invitation to and attendance at breast screening and on numbers reached by telephone were analysed by logistic regression. RESULTS: For the 29 participating GP practices (10,928 invitees) overall uptake in 2010 was higher compared to the previous screening round in 2007 (67% vs. 51%; p < 0.001). On average 59% of invitees were reached by the reminder calls. A 10% increase in women reached resulted in an 8% increase in the odds of women attending their screening appointment (95% CI: 5%-11%), after adjusting for 2007 attendance rates. Practices with a higher proportion of South Asian women were associated with a larger uptake adjusted for 2007 uptake and population reached by the telephone intervention, (4% increase in odds of attendance per 10% increase in South Asian population, CI 1%-7%, p = 0.003) while practices with a higher proportion of black women were associated with a smaller uptake similarly adjusted. (11% decrease in odds of attendance per 10% increase in black population, CI 9%-16%, p < 0.001). CONCLUSIONS: A language- and culture-sensitive programme of reminder calls substantially improved breast cancer screening uptake.

Reduction in interval cancer rates following the introduction of two-view mammography in the UK breast screening programme.

BACKGROUND: The introduction of two-view mammography at incident (subsequent) screens in the National Health Service Breast Screening Programme (NHSBSP) has led to an increased number of cancers detected at screen. However, the effect of two-view mammography on interval cancer rates has yet to be assessed. METHODS: Routine screening and interval cancer data were collated from all screening programmes in the United Kingdom for women aged 50-64, screened between 1 April 2003 and 31 March 2005. Interval cancer rates were compared based on whether two-view mammography was in use at the last routine screen. RESULTS: The reduction in interval cancers following screening using two-view mammography compared with one view was 0.68 per 1,000 women screened. Overall, this suggests the introduction of two-view mammography at incident screen was accompanied by a 15-20% reduction in interval cancer rates in the NHSBSP. CONCLUSION: The introduction of two-view mammography at incident screens is associated with a reduction in incidence of interval cancers. This is consistent with previous publications on a contemporaneous increase in screen-detected cancers. The results provide further evidence of the benefit of the use of two-view mammography at incident screens.

Population mobility: characteristics of people registering with general practices.

OBJECTIVES: The aim of this study was to examine the characteristics of patients joining general practitioners' (GP) lists, and the time taken to register after a move of residence. STUDY DESIGN: Questionnaire study. METHODS: Staff in six London general practices administered the questionnaire to 642 newly registering adults. RESULTS: Nearly 40% of participants took longer than 6 months to re-register with a GP after a change of address. About one in eight participants (13%) took longer than 1 year and one in 14 (7%) took longer than 3 years to register. The overall median time to register after a move was 4 months. The amount of time taken to register appeared to be influenced by a number of factors, including gender, age and geographical location. CONCLUSIONS: Population mobility and the time taken to register with a new GP is likely to have a major impact on access to health care and the effectiveness of local preventative health programmes. Primary care trusts need to encourage their local residents to register with a GP soon after a change of address, and develop initiatives to encourage participation in preventative health programmes amongst mobile groups. Additional measures to strengthen primary care provision, such as walk-in centres, may be required in areas with the highest levels of population turnover.

Exploring the effects of population mobility on cervical screening coverage.

London has the lowest cervical screening coverage in England and in 1998/1999 accounted for 11 of the 13 health authorities that fell below the national 80% coverage target. There are several factors which may contribute to the difference in coverage between the capital and the rest of the country. London's population is much more diverse, there is greater deprivation and there are well-established structural differences in primary care. London has high levels of population mobility which will also affect the ability of GPs to achieve high population coverage. This paper explores the possible size of the effect that population mobility is likely to have on coverage of the cervical screening programme in London. The analysis estimates the size of 'missing populations' that may not receive an invitation for a smear test, or artificially inflate the list size of registered patients. A simple model suggests that in some London Health Authorities up to 14% of residents, and 11% of patients on GP lists, may miss out on invitations for screening as a result of population mobility. Moreover the large differences between list and resident populations in some areas mean that the current government target of 80% coverage of the registered population will be largely unattainable for many London Health Authorities and Primary Care Trusts. Moving towards a resident-based system, whereby the numbers screened are related to the number of residents, avoids some of the problems associated with list inflation and gives a fairer picture of coverage of the eligible population.