Fixed date, time for backup appointment improve attendance for women who miss breast cancer screening

Participation in breast cancer screening has declined in England, especially in areas of socioeconomic disadvantage.

A new analysis, conducted by researchers from Queen Mary University of London (QMUL), revealed women who miss a first breast screening appointment and are given a fixed date for another appointment are more likely to attend that backup. This increase in attendance is also a cost-effective way to shift national participation trends.

The results, published in Lancet Oncology and led by Stephen Duffy, a professor at QMUL, outlined a randomized controlled trial that took place in six National Health Service (NHS) breast screening centers in England. The researchers tested two different approaches to see what would be more beneficial in getting a woman to come for another appointment:

  1. Supply an open invitation asking a woman to call to make an appointment.
  2. Send an invitation with a fixed date and time, requiring no effort from the invitee to book the appointment.

Some 26,000 women were part of the trial who had missed their first appointment for a breast cancer screening. Data showed a higher increase in attendance for those patients who were offered a timed appointment in the first 90 days compared to those who received an open invitation. There was also a higher increase for women with a lower socioeconomic status.

Attendance for those offered a second timed appointment increased 10.4 percent.

“We often feel that it is too difficult to change people’s behaviour, and we should just let people do what they do. But this study seems to indicate that fairly simple changes do substantially change behaviour, and can increase the rate of participation of screening," said Duffy. 

Duffy and his team also found that offering fixed appointments increased the chances of women attending a screening after not going to one in the last six years, while seeing a small increase for those who didn’t have a screening in the last nine years.

“Clinics currently overbook appointments to take account of the fact that those invited don’t all turn up, but these decisions sometimes have to be made on incomplete information. This study helps estimate how likely it is a previous non-attender would show up to their second timed appointment, and could be used to aid decisions on how much to overbook on those time slots," Duffy continued.