Objective: To compare the efficacy and cost-effectiveness of two reminding strategies addressed to women who did not respond to a first invitation to undergo cervical cancer screening. Study Design: A randomized study was carried out by a programme created in Alsace to organize cervical cancer screening. In total, 10,662 women who did not have a smear test 1 year after a first notice was sent, were randomly allocated to receive either a new letter with a reply coupon or a telephone call. The uptake of screening was measured using routine data. Efficacy and direct costs of the two methods were compared. Results: Uptake at 8 months was 6.3% [95% confidence interval (CI) 5.6–7.0%] for telephone calls and 5.8% (95% CI 5.2–6.4%) for letters. The difference was not significant. More information was collected through telephone calls than by letters, but with less reliability. Furthermore, telephone calls were more costly. Conclusions: We found that in our region, a mail reminder was as effective as, and less expensive than, a telephone call; moreover, it was applicable to the whole population, including patients without a telephone.

Tacken MA, Braspenning JC, Hermens RP, et al: Uptake of cervical cancer screening in The Netherlands is mainly influenced by women’s beliefs about the screening and by the inviting organization. Eur J Public Health 2007;17:178–185.
Buehler SK, Parsons WL: Effectiveness of a call/recall system in improving compliance with cervical cancer screening: a randomized controlled trial. CMAJ 1997;157:521–526.
Johnston GM, Boyd CJ, MacIsaac MA, Rhodes JW, Grimshaw RN: Effectiveness of letters to Cape Breton women who have not had a recent Pap smear. Chronic Dis Can 2003;24:49–56.
Rousseau A, Bohet P, Merlière J, Treppoz H, Heules-Bernin B, Ancelle-Park R: Evaluation du dépistage organisé et du dépistage individuel du cancer du col de l’utérus: utilité des données de l’Assurance maladie. Bull Epidemiol Hebdo 2002;19:81–83.
Fender M, Schott J, Baldauf JJ, Muller J, Schlund E, Dellenbach P: EVE: une campagne régionale de dépistage du cancer du col de l’utérus. Organisation, résultats à 7 ans et perspectives. Presse Méd 2003;32:1545–1551.
Aklimunnessa K, Mori M, Khan MM, et al: Effectiveness of cervical cancer screening over cervical cancer mortality among Japanese women. Jpn J Clin Oncol 2006;36:511–518.
Waxman AG: Guidelines for cervical cancer screening: history and scientific rationale. Clin Obstet Gynecol 2005;48:77–97.
Quinn M, Babb P, Jones J, Allen E: Effect of screening on incidence of and mortality from cancer of cervix in England: evaluation based on routinely collected statistics. BMJ 1999;318:904–908.
Gustafsson L, Adami HO: Cytologic screening for cancer of the uterine cervix in Sweden evaluated by identification and simulation. Br J Cancer 1990;61:903–908.
Ponten J, Adami HO, Bergström R, et al: Strategies for global control of cervical cancer. Int J Cancer 1995;60:1–26.
Lynge E, Clausen LB, Guignard R, Poll P: What happens when organization of cervical cancer screening is delayed or stopped? J Med Screen 2006;13:41–46.
Nygard JF, Skare GB, Thoresen SO: The cervical cancer screening programme in Norway, 1992–2000: changes in Pap smear coverage and incidence of cervical cancer. J Med Screen 2002;9:86–91.
Bergström R, Sparen P, Adami HO: Trends in cancer of the cervix uteri in Sweden following cytological screening. Br J Cancer 1999;81:159–166.
Bos AB, Van Ballegooijen M, Van Gessel-Dabekaussen AA, Habbema JD: Organised cervical cancer screening still leads to higher coverage than spontaneous screening in The Netherlands. Eur J Cancer 1998;34:1598–1601.
Sigurdsson K: Effect of organized screening on the risk of cervical cancer. Evaluation of screening activity in Iceland, 1964–1991. Int J Cancer 1993;54:563–570.
Lynge E, Madsen M, Engholm G: Effect of organized screening on incidence and mortality of cervical cancer in Denmark. Cancer Res 1989;49:2157–2160.
Nieminen P, Kallio M, Anttila A, Hakama M: Organised vs spontaneous Pap smear screening for cervical cancer: a case-control study. Int J Cancer 1999;83:55–58.
Cahier des charges du dépistage organisé du cancer du col de l’utérus. Direction Générale de la Santé, Décembre 2006. www.sante.gouv.fr/htm/dossiers/cancer_uterus/cctp.pdf (accessed October 2, 2009).
Adami HO, Ponten J, Sparen P, Bergström R, Gustafsson L, Friberg LG: Survival trend after invasive cervical cancer diagnosis in Sweden before and after cytologic screening. 1960–1984. Cancer 1994;73:140–147.
Duport N, Haguenoer K, Ancelle-Park R, Bloch J: Evaluation épidémiologique des quatre départements ‘pilotes’. Institut de Veille Sanitaire, June 2007. www.invs.sante.fr/publications (accessed October 2, 2009).
Tseng DS, Cox E, Plane MB, Hla KM: Efficacy of patient letter reminders on cervical screening: a meta-analysis. J Gen Intern Med 2001;16:563–568.
Institut National de la Statistique et des Etudes Economiques: Enquêtes annuelles de recensement 2004 à 2006 – exploitation principale. www.insee.fr/fr/bases-de-donnees (accessed October 2, 2009).
Stein K, Lewendon G, Jenkins R, Davis C: Improving uptake of cervical cancer screening in women with prolonged history of non-attendance for screening: a randomized trial of enhanced invitation methods. J Med Screen 2005;12:185–189.
Oscarsson MG, Benzein EG, Wijma BE, Carlsson PG: Promotion of cervical screening among nonattendees: a partial cost-effectiveness analysis. Eur J Cancer Prev 2007;16:559–563.
Piana L, Leandri FX, Jacqueme B, et al: Le dépistage organisé des cancers du col utérin pour les femmes en situation médicosociale défavorisée. Campagnes expérimentales du département des Bouches-du-Rhône. Bull Cancer 2007;94:1–7.
Richardson A, Williams S, Elwood M, Bahr M, Medlicott T: Participation in breast cancer screening: randomised controlled trials of doctors’ letters and of telephone reminders. Aust J Public Health 1994;18:290–292.
Page A, Morrell S, Chiu C, Taylor R, Tewson R: Recruitment to mammography screening: a randomised trial and meta-analysis of invitation letters and telephone calls. Aust NZ J Public Health 2006;30:111–118.
Eaker S, Adami HO, Granath F, Wilander E, Sparen P: A large population based randomized controlled trial to increase attendance at screening for cervical cancer. Cancer Epidemiol Biomarkers Prev 2004;13:346–354.
Miller SM, Siejak KK, Schroeder CM, Lerman C, Hernandez E, Helm CW: Enhancing adherence following abnormal Pap smears among low-income minority women: a preventive telephone counseling strategy. J Natl Cancer Inst 1997;89:703–708.
Luckmann R, Savageau JA, Clemow L, Stoddard AM, Costanza ME: A randomized trial of telephone counseling to promote screening mammography in two HMOs. Cancer Detect Prev 2003;27:442–450.
Basch CE, Wolf RL, Brouse CH, et al: Telephone outreach to increase colorectal cancer screening in an urban minority population. Am J Public Health 2006;96:2246–2253.
Taplin SH, Barlow WE, Ludman E, et al: Testing reminder and motivational telephone calls to increase screening mammography: a randomized study. J Natl Cancer Inst 2000;92:233–242.
Vinker S, Nakar S, Rosenberg E, Kitai E: The role of family physicians in increasing annual fecal occult blood test screening coverage: a prospective intervention study. Isr Med Assoc J 2002;4:424–425.
Davis NA, Nash E, Bailey C, Lewis MJ, Rimer BK, Koplan JP: Evaluation of three methods for improving mammography rates in a managed care plan. Am J Prev Med 1997;13:298–302.
Bais AG, van Kemenade FJ, Berkhof J, et al: Human papillomavirus testing on self-sampled cervicovaginal brushes: an effective alternative to protect nonresponders in cervical cancer screening programs. Int J Cancer 2007;120:1505–1510.
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