1. Evaluation of interventions to improve breast screening uptake in London Judith Offman, Stephen Duffy Wolfson Institute of Preventive Medicine
Sarojini Ariyanayagam, Zoraida Colorado, Martin Sharp, Matthew Cruice, Anna Garner, Sukhjit Sanghera, Susan Shiel, Maggie Luck, Maxine Farmer, Claire Bailey, Anna O'Neill, Debbie Brazil, Tim Baker, Louise Wilkinson, Gillian Holdsworth, Tamara Djuretic, Rorie Jefferies, Kathie Binysh

2. Breast Cancer Screening
Women from age 50 to 70 invited for mammogram every 3 years
Women invited by post
Attendance UK wide 73%
Attendance in London always lower ~ 63%
Attendance rates shown to be lower for certain ethnic groups, specifically Black and South Asians women in the UK

3. Projects in London to increase screening
Considerable activity
Numerous interventions over the past five years
For example
South West London: trial of pre-invitation reminder letters
Newham post-invitation telephone reminders project
Next slide summary of all London projects, but but will focus on Newham telephone reminders

4. Summary of interventions in improve breast screening uptake in London
All CELBSS PCTs – Practice staff update and training – beginning to see GP update data increase
City and Hackney – DNA Project (13 practices) – ???? Look up!!
Brent – 2nd timed appointments for DNA women – increase in total uptake by 4%
City & Hackney- Local Enhanced Services (LES): 18 practices; DNA project: 5 practices; Media campaigns - Uptake increased from 49.1 to 53.3% compared to the previous round
SWLBSS – phone survey of non-attenders with appointment scheduling offer– 505 appointments made, 46% attended
City & Hackney- New specifications for Local Enhanced Services (LES): 10/12 practices; In-round and 2nd timed reminder calls - Uptake increased from?? to ??? compared to the previous round
SWLBSS – pre-invitation letter pilot– 3 surgeries, ½ of women were sent letters, ~ 5% increase in uptake in group with pre-invitation letter compared to without
Camden – DNA project (Oct 09) – more than 50% of women could not be contacted; 50% of women contacted attended screening
Lewisham / Lambeth / Southwark – Phone calls and letters to DNA women – 10% of DNA attend a new appointment
Newham - iPlato text reminders – 11 surgeries, 10% of women reached, 77% attendance rate amongst women texted
Tower Hamlets – women known to CELBSS are called to remind them about their appointments including second time appointments– 23/27 practices had improved breast screening coverage, with 11 practices gaining more than 3% increase in coverage.
Newham – Reminder calls for breast screening appointments pilot – very successful at increasing uptake and coverage
Camden – pink party pilot (jan 09) – 54 / 56 booked appointment
Camden - Welcome screening information pack – uptake increase
Newham - iPlato text reminders – 6 surgeries, 20% of women reached, 56% attendance rate amongst women texted
Camden – Data reconciliation and contact strategy pilot (Sep 10 – Mar 11) for women who DNA’d or have never been screened (number of interventions including telephone contact and OOH clinics) – 76% of DNA women contacted were subsequently screened, resulting in total uptake of 64% for the project
Newham - Invitation letter re-design pilot (3 months) – no negative impact
Borough of Tower Hamlets - Talking invitation – only impact in Bangladeshi women
2009
2008
2011
2010

5. Summary of interventions in improve breast screening uptake in London
All CELBSS PCTs – Practice staff update and training – beginning to see GP update data increase
City and Hackney – DNA Project (13 practices) – ???? Look up!!
Brent – 2nd timed appointments for DNA women – increase in total uptake by 4%
City & Hackney- Local Enhanced Services (LES): 18 practices; DNA project: 5 practices; Media campaigns - Uptake increased from 49.1 to 53.3% compared to the previous round
Newham – Reminder calls for breast screening appointments pilot – very successful at increasing uptake and coverage
SWLBSS – phone survey of non-attenders with appointment scheduling offer– 505 appointments made, 46% attended
City & Hackney- New specifications for Local Enhanced Services (LES): 10/12 practices; In-round and 2nd timed reminder calls - Uptake increased from?? to ??? compared to the previous round
SWLBSS – pre-invitation letter pilot– 3 surgeries, ½ of women were sent letters, ~ 5% increase in uptake in group with pre-invitation letter compared to without
Camden – DNA project (Oct 09) – more than 50% of women could not be contacted; 50% of women contacted attended screening
Lewisham / Lambeth / Southwark – Phone calls and letters to DNA women – 10% of DNA attend a new appointment
Newham - iPlato text reminders – 11 surgeries, 10% of women reached, 77% attendance rate amongst women texted
Tower Hamlets – women known to CELBSS are called to remind them about their appointments including second time appointments– 23/27 practices had improved breast screening coverage, with 11 practices gaining more than 3% increase in coverage.
Newham – Reminder calls for breast screening appointments pilot – very successful at increasing uptake and coverage
Camden – pink party pilot (jan 09) – 54 / 56 booked appointment
Camden - Welcome screening information pack – uptake increase
Newham - iPlato text reminders – 6 surgeries, 20% of women reached, 56% attendance rate amongst women texted
Camden – Data reconciliation and contact strategy pilot (Sep 10 – Mar 11) for women who DNA’d or have never been screened (number of interventions including telephone contact and OOH clinics) – 76% of DNA women contacted were subsequently screened, resulting in total uptake of 64% for the project
Newham - Invitation letter re-design pilot (3 months) – no negative impact
Borough of Tower Hamlets - Talking invitation – only impact in Bangladeshi women
2009
2008
2011
2010

6. Newham Breast Screening Take-up Project
Commissioned Community Links to improve uptake
Community Links recruited local ‘callers’ to telephone invitees from their general practice after invitation
Culture and language sensitive
Confirm receipt of invitation
Offer information / answer questions
Call women who did not attend their appointment to remind to reorganise appointment

7. Project design
No control group- aim to cover as many invitees as possible
Numbers contacted varied substantially from practice to practice
Gives opportunity to study the relationship between the proportion of the target contacted and the screening attendance in the practice

8. Telephone calls made and responses
Number of telephone calls made
Reason
Invitees
will attend
4467
Re-scheduled
888
Holidays
260
Had one recently
182
Unwell 61
Fear or result 11
Didn't received letter 29
Not attending, No reason
220
Too Painful 27
Advocacy Needed 33
Feels Fine
Left Practice 43
Wrong address 4
total women reached
6236
Phone contact attempted
Invitees
Invitees (%)
Reached
6236
64%
Could not be reached
3541
36%
Total contact attempted
9777
100%

9. Overall improvement
Attendance rates improved from 51% to 67% between 2007 and 2010 screening invitations
In the reminder project a median of 61% of invitees were contacted
Small number of women sent text reminder
Only data by GP practice available

10. Attendance rate by GP practice
Comparing attendance in 2010 with 2007
The more women reached at each practice the bigger the increase in attendance

11. Effect of intervention
Greater increase in uptake between 2007 and 2010 was observed in practices which contacted larger numbers of invitees (p=0.001)
Around 20% of the improvement was estimated to be attributable to the intervention

12. Ethnicity by GP practice in Newham
Large proportion of South Asian women

13. Increase in attendance rate by ethnicity
The higher the proportion of South Asian women for a GP practice, the higher the increase in attendance rate

14. Acknowledgements
Centre for Cancer Prevention Barts and The London Medical School Prof Stephen Duffy Jonathan Myles Community Links Zoraida Colorado Centre for Primary Care & Public Health, Blizard Institute, QMUL Martin Sharp
London Breast Cancer Screening Services
and former London PCTs
Sarojini Ariyanayagam
Matthew Cruice
Anna Garner
Sukhjit Sanghera
Susan Shiel
Maggie Luck
Maxine Farmer
Claire Bailey
Anna O'Neill
Debbie Brazil
Tim Baker
Louise Wilkinson
Gillian Holdsworth
Tamara Djuretic
Rorie Jefferies
Kathie Binysh