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Evidence summaries

Interventions to Encourage the Uptake of Cervical Screening

Invitation letters and automated reminders appear to increase the uptake of cervical cancer screening slightly compared with usual care. Level of evidence: "B"

Comment: The certainty of evidence is downgraded by study quality (unclear allocation concealment in almost half of the studies).

A Cochrane review [Abstract] 1 included 69 studies with a total of 257 899 participants. Overall, invitations appeared to be effective methods of increasing uptake (RR 1.71, 95% CI 1.49 to 1.96; 24 trials, n=141 391). Personalised invitations and letters with a fixed appointment to attend were more successful than standard invitations. In addition, there was limited evidence to support the use of educational materials (RR 1.35, 95% CI 1.18 to 1.54; 13 trials, n=63 415).

Another Cochrane review [Abstract] 2 assessed the effect of automated telephone communication systems (ATCS) on cervical cancer screening. ATCS Plus (ATCS with additional functions such as access to an expert to request advice) interventions slightly increased cervical cancer screening compared with usual care (45 303 versus 30 229 (moderate certainty).

A three-armed cluster randomized control trial 3 in France involving 148 510 women and 1070 general practitioners. A new invitation letter was sent to non-adherent women and a list to general practitioners of their non-adherent patients. Among the 64 370 initially non-adherent women, screening uptake was 17.9 % in the Optimized screening group vs 11.6 % in the Usual care group (OR 1.7, 95 % CI 1.56 to 1.86). There was no significant difference between Optimized and Organized screening groups (17.2 % vs 17.9 %).

    References

    • Staley H, Shiraz A, Shreeve N et al. Interventions targeted at women to encourage the uptake of cervical screening. Cochrane Database Syst Rev 2021;(9):CD002834. [PubMed]
    • Posadzki P, Mastellos N, Ryan R et al. Automated telephone communication systems for preventive healthcare and management of long-term conditions. Cochrane Database Syst Rev 2016;(12):CD009921. [PubMed]
    • Teigné D, Banaszuk AS, Grimault C, et al. Organized cervical cancer screening: A randomized controlled trial assessing the effect of sending invitation letters. Prev Med 2024;189():108150.[PubMed]

Primary/Secondary Keywords