Mammography screening attendance: meta-analysis of the effect of direct-contact invitation.

BACKGROUND: Personal or telephone contact methods are often used to increase attendance for mammography screening. A meta-analysis of the literature was performed to assess the overall effect of direct-contact recruitment on mammography participation.
METHODS: Two independent reviewers conducted two different search strategies. Each reviewer screened the search results for (quasi-)randomized-controlled trials that tested single women-targeted interventions. Twenty-one of 22 candidate studies that met the inclusion criteria could be included. These studies described 25 eligible interventions. Guided by a standardized protocol, a reviewer assessed the methodologic quality of each intervention and extracted the following data: (1) the number of women (from experimental and control groups) before and after the intervention, (2) details of the study population, (3) the type of intervention, and (4) the control condition. On the basis of a quality ranking, a cumulative random-effects meta-analysis was performed using relative risk as an indicator of intervention effect.
RESULTS: Depending on the cumulative step, the analysis revealed that direct-contact strategies improved attendance from 21% (95% confidence interval [CI]; 10%-34%) to 46% (95% CI; 32%-61%).
CONCLUSIONS: Evidence from experimental studies supports the effect of direct-contact strategies in which women are invited to participate in mammography screening. Future research will have to define the specific modalities in which these interventions can be adopted in a cost-effective manner.