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.

Conspicuity of breast cancer according to histopathological type and breast density when imaged by full-field digital mammography compared with screen-film mammography.

OBJECTIVES: To compare the conspicuity of different histopathological types of breast cancer according to breast density and mammographic imaging in patients with screen-detected breast cancers undergoing both full-field digital mammography (FFDM) and screen-film mammography (SFM) in the United Kingdom National Health Service Breast Screening Programme (NHSBSP). METHODS: 185 patients underwent routine screening with SFM followed by further imaging using FFDM with consequent diagnosis of breast cancer. All SFM and soft-copy FFDM images were evaluated by two readers in an independent, retrospective review. The visualisation and conspicuity of the mammographic abnormality were recorded and graded using a four-level scale. Conspicuity of breast cancer was qualitatively evaluated. Breast density and conspicuity were correlated with histopathological diagnosis and inter-observer correlation was calculated. RESULTS: Mixed Model ANOVA demonstrated significant differences between FFDM and SFM (p<0.001) and breast densities (p=0.009): conspicuity of the mammographic abnormality (p<0.001) and visualisation of the dominant mammographic feature (p<0.001) were significantly greater with FFDM than SFM. This held true for both readers and for all histopathological tumour types with no significant differences between each tumour type. CONCLUSION: FFDM is significantly superior to SFM for conspicuity of screen-detected breast cancers for all histopathological types and breast densities.