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Methods to increase participation in organised screening programs: a systematic review

Laura Camilloni1, Eliana Ferroni2, Beatriz Jimenez Cendales1, Annamaria Pezzarossi3, Giacomo Furnari1, Piero Borgia1, Gabriella Guasticchi1, Paolo Giorgi Rossi34* and the Methods to increase participation Working Group

Author Affiliations

1 Laziosanità – Agency for Public Health, Lazio Region, Rome, Italy

2 Epidemiology Department, Lazio Region, Rome, Italy

3 Epidemiology Unit, AUSL Reggio Emilia, Reggio Emilia, Italy

4 AUSL Reggio Emilia, via Amendola 2, Reggio Emilia, Italy

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BMC Public Health 2013, 13:464  doi:10.1186/1471-2458-13-464

Published: 13 May 2013



The European Community recommends the implementation of population-based screening programmes for cervical, breast, and colorectal cancers. This recommendation is supported by many observational studies showing that organised programmes effectively reduce mortality and control the inappropriate use of screening tests. We conducted a systematic review of studies assessing the efficacy of interventions to increase participation in organised population-based screening programs.


We included all studies on interventions aimed at increasing screening participation published between 1/1999 and 7/2012. For those published before 1999, we considered the Jepson et al. (2000) review (Health Technol Assess 4:1-133, 2000).


Including studies from the Jepson review, we found 69 with quantitative information on interventions in organised screening: 19 for cervical, 26 for breast, 20 colorectal cancers, and 4 for cervical and breast cancer together.

Effective interventions were: postal (breast RR = 1,37 95% Confidence Interval (95% CI): 1.25-1.51; cervical RR = 1.71 95% CI: 1.60-1.83; colorectal RR = 1.33 95% CI: 1.17-1.51) and telephone reminders (with heterogeneous methods for implementation); GP’s signature on invitation letter (breast RR = 1.13 95% CI: 1.11-1.16; cervical RR = 1.20 95% CI: 1.10-1.30; colorectal RR = 1.15 95% CI: 1.07-1.24); scheduled appointment instead of open appointment (breast RR = 1.26 95% CI: 1.02-1.55; cervical RR = 1.49 95% CI: 1.27-1.75; colorectal RR = 1.79 95% CI: 1.65-1.93). Mailing a kit for self-sampling cervical specimens increased participation in non-responders (RR = 2.37 95% CI: 1.44-3.90).


Although some interventions did prove to be effective, some specific variables may influence their effectiveness in and applicability to organised population-based screening programs.

Mass screening; Participation; Systematic review; Cancer