Effect of second timed appointments for non-attenders of breast cancer screening in England: a randomised controlled trial
Open accessAbstract
BACKGROUND: In England, participation in breast cancer screening has been decreasing in the past 10 years, approaching the national minimum standard of 70%. Interventions aimed at improving participation need to be investigated and put into practice to stop this downward trend. We assessed the effect on participation of sending invitations for breast screening with a timed appointment to women who did not attend their first offered appointment within the NHS Breast Screening Programme (NHSBSP). METHODS: In this open, randomised controlled trial, women in six centres in the NHSBSP in England who were invited for routine breast cancer screening were randomly assigned (1:1) to receive an invitation to a second appointment with fixed date and time (intervention) or an invitation letter with a telephone number to call to book their new screening appointment (control) in the event of non-attendance at the first offered appointment. Randomisation was by SX number, a sequential unique identifier of each woman within the NHSBSP, and at the beginning of the study a coin toss decided whether women with odd or even SX numbers would be allocated to the intervention group. Women aged 50-70 years who did not attend their first offered appointment were eligible for the analysis. The primary endpoint was participation (ie, attendance at breast cancer screening) within 90 days of the date of the first offered appointment; we used Poisson regression to compare the proportion of women who participated in screening in the study groups. All analyses were by intention to treat. This trial is registered with Barts Health, number 009304QM. FINDINGS: We obtained 33 146 records of women invited for breast cancer screening at the six centres between June 2, 2014, and Sept 30, 2015, who did not attend their first offered appointment. 26 054 women were eligible for this analysis (12 807 in the intervention group and 13 247 in the control group). Participation within 90 days of the first offered appointment was significantly higher in the intervention group (2861 [22%] of 12 807) than in the control group (1632 [12%] of 13 247); relative risk of participation 1·81 (95% CI 1·70-1·93; p<0·0001). INTERPRETATION: These findings show that a policy of second appointments with fixed date and time for non-attenders of breast screening is effective in improving participation. This strategy can be easily implemented by the screening sites and, if combined with simple interventions, could further increase participation and ensure an upward shift in the participation trend nationally. Whether the policy should vary by time since last attended screen will have to be considered. FUNDING: National Health Service Cancer Screening Programmes and Department of Health Policy Research Programme.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
A United Kingdom-based letter study showed higher mammography participation (22%) for previous non-attenders with a fixed appointment than for those who could freely book a time (12%).
“A United Kingdom-based letter study showed higher mammography participation (22%) for previous non-attenders with a fixed appointment than for those who could freely book a time (12%) [52].”
From Improving cancer screening uptake: A behavioural and cultural insights perspective and rapid review (2026) · cites this paper as [52]
Invitations in different forms (e.g., letters, text messages, phone calls) have increased cancer screening.
“Invitations in different forms have increased cancer screening (e.g., letters, text messages, phone calls) [42,51,52].”
From Improving cancer screening uptake: A behavioural and cultural insights perspective and rapid review (2026) · cites this paper as [52]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
The English Indices of Deprivation 2010
McLennan, D., Barnes, H., Noble, M., Davies, J., Garrett, E., & Dibben, C. J. L. (2011) · Cited by 591 · see citing works
Maheswaran, R., Pearson, T., Jordan, H., & Black, D. (2006) · Journal of Epidemiology & Community Health · doi:10.1136/jech.200x.038398 · Cited by 185 · see citing works
Szczepura, A. K., Price, C., & Gumber, A. (2008) · BMC Public Health · doi:10.1186/1471-2458-8-346 · Cited by 148 · see citing works
Kerrison, R., Shukla, H., Cunningham, D., Oyebode, O. O., & Friedman, E. (2015) · British Journal of Cancer · doi:10.1038/bjc.2015.36 · Cited by 109 · see citing works
Douglas, E., Waller, J., Duffy, S. W., & Wardle, J. (2015) · Journal of Medical Screening · doi:10.1177/0969141315600192 · Cited by 102 · see citing works
Self-citationSegnan, N., Seriore, C., Giordano, L., Ponti, A., & Ronco, G. (1998) · Tumori Journal · doi:10.1177/030089169808400307 · Cited by 62 · see citing works
Approaches to improving breast screening uptake: evidence and experience from Tower Hamlets
Eilbert, K. W., Carroll, K. T., Peach, J., Khatoon, S., Basnett, I., & McCulloch, N. (2009) · British Journal of Cancer · doi:10.1038/sj.bjc.6605393 · Cited by 44 · see citing works
Rutqvist, L. E., & Bern, A. (2006) · International Journal of Cancer · doi:10.1002/ijc.21949 · Cited by 42 · see citing works
Madadi, M., Zhang, S., Yeary, K. H. K., & Henderson, L. M. (2014) · Breast Cancer Research and Treatment · doi:10.1007/s10549-014-2850-9 · Cited by 30 · see citing works
A telephone reminder intervention to improve breast screening information and access
Offman, J., Myles, J. P., Ariyanayagam, S., Colorado, Z., Sharp, M., Cruice, M. N., North, B. V., Shiel, S., Baker, T., Jefferies, R., et al. (2014) · Public Health · doi:10.1016/j.puhe.2014.09.007 · Cited by 29 · see citing works
Self-citationLawrence, G., O’Sullivan, E., Kearins, O., Tappenden, N., Martin, K. L., & Wallis, M. (2009) · Journal of Medical Screening · doi:10.1258/jms.2009.009040 · Cited by 28 · see citing works
Giordano, L., Stefanini, Senore, C., Frigerio, A., Castagno, R., Marra, V., Dalmasso, M., Turco, M. R. D., Paci, E., & Segnan, N. (2011) · European Journal of Public Health · doi:10.1093/eurpub/ckr090 · Cited by 27 · see citing works
Improving uptake in non-attenders of breast screening: selective use of second appointment
Stead, M. J., Wallis, M., & Wheaton, M. (1998) · Journal of Medical Screening · doi:10.1136/jms.5.2.69 · Cited by 27 · see citing works
A randomised trial of weekend and evening breast screening appointments
Offman, J., Wilson, M., Lamont, M., Birke, H., Kutt, E., Marriage, S., Loughrey, Y., Hudson, S. M., Hartley, A., Smith, J. L., et al. (2013) · British Journal of Cancer · doi:10.1038/bjc.2013.377 · Cited by 25 · see citing works
Self-citationWang, C. (2016) · Journal of Transport Geography · doi:10.1016/j.jtrangeo.2016.08.012 · Cited by 23 · see citing works
A randomised trial of the effect of postal reminders on attendance for breast screening
Allgood, P. C., Maxwell, A., Hudson, S. M., Offman, J., Hutchison, G., Beattie, C., Tuano-Donnelly, R., Threlfall, A., Summersgill, T., Bellis, L., et al. (2016) · British Journal of Cancer · doi:10.1038/bjc.2015.451 · Cited by 21 · see citing works
Self-citationHudson, S. M., Brazil, D., Teh, W., Duffy, S. W., & Myles, J. P. (2016) · Journal of Medical Screening · doi:10.1177/0969141315624937 · Cited by 18 · see citing works
Self-citationGiorgi, D., Giordano, L., Senore, C., Merlino, G., Negri, R., Cancian, M., Lerda, M., Segnan, N., Turco, M. R. D., the Working Group, et al. (2000) · Tumori Journal · doi:10.1177/030089160008600203 · Cited by 18 · see citing works
[Can a mobile phone short message increase participation in breast cancer screening programmes?].
Arcas, M. M., Burón, A., Ramis, O., Esturi, M., Hernández, C., & Maciá, F. (2014) · Revista de Calidad Asistencial · doi:10.1016/j.cali.2014.02.003 · Cited by 13 · see citing works
Goossens, M., Hal, G. F. V., van der Burg, M., Kellen, E., Herck, K. V., Grève, J. D., Martens, P., & Limbergen, E. V. (2014) · Preventive Medicine · doi:10.1016/j.ypmed.2014.10.019 · Cited by 13 · see citing works
Berardi, R., Nacciarriti, D., Tamburrano, T., Carbonari, G., Romagnoli, E., Duca, M., Burattini, M., Silva, R. R., Cellerino, R., & Cascinu, S. (2013) · Tumori Journal · doi:10.1177/030089161309900501 · Cited by 8 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Vallone, F., Lemmo, D., Martino, M. L., Donizzetti, A. R., Freda, M. F., Palumbo, F., Lorenzo, E., D’Argenzio, A., & Caso, D. (2022) · Psycho-Oncology · doi:10.1002/pon.5997 · Cited by 65 · see citing works
Understanding Patient Factors to Increase Uptake of Cancer Screening: a Review
Young, B., & Robb, K. A. (2021) · Future Oncology · doi:10.2217/fon-2020-1078 · Cited by 66 · see citing works
Wilson, R., & Winnard, Y. (2022) · Journal of Health Organization and Management · doi:10.1108/jhom-11-2021-0425 · Cited by 47 · see citing works
Dickson, J. L., Hall, H., Horst, C., Tisi, S., Verghese, P., Mullin, A., Teague, J. W., Farrelly, L., Bowyer, V., Gyertson, K., et al. (2023) · The Lancet Public Health · doi:10.1016/s2468-2667(22)00258-4 · Cited by 47 · see citing works
Zabih, V., Kahane, A., O'Neill, N. E., Ivers, N. M., & Nathan, P. C. (2019) · Journal of Cancer Survivorship · doi:10.1007/s11764-019-00790-w · Cited by 39 · see citing works
Lagerlund, M., Åkesson, A., & Zackrisson, S. (2021) · The Breast · doi:10.1016/j.breast.2021.05.011 · Cited by 30 · see citing works
Educational inequalities in cervical cancer screening participation in 24 European countries
Altová, A., Kulhánová, I., Reisser, K., Netrdová, P., Brož, J., Eikemo, T. A., Balaj, M., & Lustigová, M. (2024) · Public Health · doi:10.1016/j.puhe.2024.04.036 · Cited by 22 · see citing works
Njor, S. H., Søborg, B., Tranberg, M., & Rebolj, M. (2022) · Preventive Medicine · doi:10.1016/j.ypmed.2022.107405 · Cited by 19 · see citing works
Larsen, M., Moshina, N., Sagstad, S., & Hofvind, S. S. H. (2020) · Journal of Medical Screening · doi:10.1177/0969141320932945 · Cited by 19 · see citing works
Ma, Z., He, W., Zhang, Y., Mao, X., Tapia, J., Hall, P. N., Humphreys, K., & Czene, K. (2025) · BMJ · doi:10.1136/bmj-2025-085029 · Cited by 15 · see citing works
Hudson, S. M., Binysh, K., & Duffy, S. W. (2022) · Journal of Medical Screening · doi:10.1177/09691413221127583 · Cited by 10 · see citing works
Self-citationFerrari, A., Herrera, D. J., van de Veerdonk, W., D’haenens, W., Ruíz-Alejos, A., Yimer, N. B., Orwa, S., Bos, L. V., Talboom, S., Ding, L., et al. (2025) · Public health reviews · doi:10.3389/phrs.2025.1607873 · Cited by 9 · see citing works
Goossens, M. M., Kellen, E., Broeders, M. J. M., Vandemaele, E., Jacobs, B., & Martens, P. (2023) · European Journal of Public Health · doi:10.1093/eurpub/ckad137 · Cited by 8 · see citing works
Duffy, S. W., Hudson, S. M., Vulkan, D., Duffy, T. E., & Binysh, K. (2022) · Journal of Medical Screening · doi:10.1177/09691413211066476 · Cited by 6 · see citing works
Self-citationOECD Reviews of Public Health: Latvia
OECD (2020) · OECD reviews of public health · doi:10.1787/e9f33098-en · Cited by 5 · see citing works
Vives, N., Vidal, C., de Guzmán, E. N., Farré, A., Panera, J. A., Binefa, G., & García, M. (2024) · PLoS ONE · doi:10.1371/journal.pone.0306720 · Cited by 4 · see citing works
Jeffers, S., Pilnick, A., & Armstrong, N. (2024) · BMJ Open · doi:10.1136/bmjopen-2024-089155 · Cited by 4 · see citing works
Goossens, M., & Tran, T. N. (2025) · European Journal of Public Health · doi:10.1093/eurpub/ckaf028 · Cited by 3 · see citing works
Zhao, Q., Huang, X., Ye, Z., Ruan, G., Wang, Y., Sun, P., & Xu, J. (2025) · BMC Women s Health · doi:10.1186/s12905-025-04074-7 · Cited by 2 · see citing works
Stoffel, S., Hirst, Y., Ghanouni, A., Waller, J., & von Wagner, C. (2020) · Psychology and Health · doi:10.1080/08870446.2020.1834559 · Cited by 2 · see citing works
Behavioral Economics and Breast Cancer Screening: Looking Beyond Patient Cost
Huf, S. W., & Mehta, S. J. (2018) · Journal of Women s Health · doi:10.1089/jwh.2018.7466 · Cited by 2 · see citing works
Naseri, N., Taleghani, F., Hashemi, M. S., & Najimi, A. (2024) · BMC Women s Health · doi:10.1186/s12905-024-03392-6 · Cited by 1 · see citing works
Onyedum, O., Singh, P., Tan, T. K., Kannan, A. K., Reehana, S., Mohindroo, R., & Mittal, R. (2025) · Cureus · doi:10.7759/cureus.87788 · Cited by 1 · see citing works
Haverkate, M. R., van de Kassteele, J., van den Hof, S., Sanders, J. G., Lambooij, M., de Bruin, M., de Melker, H. E., & Hahné, S. J. M. (2026) · Vaccine · doi:10.1016/j.vaccine.2026.128565 · Cited by 1 · see citing works
Mammography screening: please don't be vague, tell me when I should come!
Rossi, P. G., & Giordano, L. (2017) · The Lancet Oncology · doi:10.1016/s1470-2045(17)30344-3 · Cited by 1 · see citing works
Determinants for non-attendance in abdominal aortic aneurysm (AAA) screening
Mansoor, S. M., Jorgensen, J. J., Grønvold, T., Hisdal, J., & Rabben, T. (2024) · JVS-Vascular Insights · doi:10.1016/j.jvsvi.2024.100070 · Cited by 1 · see citing works
Improving cancer screening uptake: A behavioural and cultural insights perspective and rapid review
Palsola, M., Likki, T., Snijders, V., Corbex, M., Lasierra, L., & Curtis, B. (2026) · Glasnik javnog zdravlja · doi:10.5937/serbjph2601086p
Factors Associated With No-Show Rates for Lung Cancer Screening CT Scan Appointments
Sun, J. D., Samuylov, A. L., Lorusso, J. A., Hammer, M. M., & Byrne, S. C. (2025) · CHEST Journal · doi:10.1016/j.chest.2025.02.035
Haverkate, M. R., van de Kassteele, J., van den Hof, S., Sanders, J. G., Lambooij, M., de Bruin, M., de Melker, H. E., & Hahné, S. (2025) · medRxiv · doi:10.1101/2025.07.10.25331000
Zafar, A., Koch, M., Weller, L., Tschobur, N., Ihrig, A., Bugaj, T. J., Mayer, G., & Baessler, F. (2025) · BMC Public Health · doi:10.1186/s12889-025-23656-6
Dou, J., & Liu, Z. P. (2026) · Health Psychology Review · doi:10.1080/17437199.2026.2623887
Cullum, C., Mason, C., & Meyrick, J. (2026) · Journal of Health Psychology · doi:10.1177/13591053261420673
Brietzke, S. C., Shermohammed, M., Goren, A., Rosenbaum, G. M., Meyer, M. N., & Chabris, C. F. (2026) · JAMIA Open · doi:10.1093/jamiaopen/ooag064
Li, S. J., Brentnall, A. R., Cookson, J., Hudson, S., Quaife, S. L., Webb, S., O’Sullivan, E., Jenkins, J., Waller, J., Duffy, S. W., et al. (2026) · British Journal of Cancer · doi:10.1038/s41416-026-03436-8
Self-citationSAIMSARA (2026) · SAIMSARA Journal · doi:10.62487/saimsarabe3a427b
Chapman, S., Fenech, B., Tsangari, H., & Gaffiero, D. (2026) · Women s Health · doi:10.1177/17455057261484363
- Authors
- Allgood, P. C., Maroni, R., Hudson, S., Offman, J., Turnbull, A. E., Peacock, L., Steel, J., Kirby, G., Ingram, C. E., Somers, J., Fuller, C., Threlfall, A. G., Gabe, R., Maxwell, A. J., Patnick, J., & Duffy, S. W.
- Affiliations
- University of London (GB)
- Royal Derby Hospital (GB)
- Hull University Teaching Hospitals NHS Trust (GB)
- Derriford Hospital (GB)
- King's College Hospital NHS Foundation Trust (GB)
- Royal Hallamshire Hospital (GB)
- Imperial College Healthcare NHS Trust (GB)
- University of York (GB)
- University of Manchester (GB)
- University of Oxford (GB)
- Corresponding author
- Duffy, Stephen W
- ORCID
- Venue
- The Lancet Oncology
- Publisher
- Elsevier BV
- Published
- 2017-07
- Volume
- 18
- Issue
- 7
- Pages
- 972-980
- ISSN
- 1470-2045 (ISSN-L)
- PMC
- PMC5489696
- OpenAlex
- W2615860230
- Cited by
- 36
- References
- 21
- Citations by year
- 2026: 8 · 2025: 8 · 2024: 5 · 2023: 2 · 2022: 5 · 2021: 2 · 2020: 3 · 2019: 1 · 2018: 1 · 2017: 1
- FWCI
- 0.72
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- The Lancet Oncology (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (submittedVersion)
- Research Explorer (The University of Manchester) (submittedVersion, cc-by)
- Funders
- Queen Mary University of London
- Cancer Research UK (16892, 16893)
- National Institute for Health and Care Research (NF-SI-0513-10092)
- King's College London
- University College London
- Durham University
- Topics
- Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Women's cancer prevention and management
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Digital Radiography and Breast Imaging
- Keywords
- breast cancer screening, screening uptake, appointment non-attendance, NHS Breast Screening Programme, screening invitations, England
- MeSH terms
- Aged, Appointments and Schedules, Breast Neoplasms, England, Female, Humans, Mammography, Middle Aged, Patient Compliance, Time Factors, Early Detection of Cancer
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
