Department of Gastroenterology and Hepatology, Erasmus University Medical Centre,'s Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands.
Prev Med. 2011 Jun;52(6):448-51. doi: 10.1016/j.ypmed.2011.01.032. Epub 2011 Mar 30.
The population benefit of screening depends not only on the effectiveness of the test, but also on adherence, which, for colorectal cancer (CRC) screening remains low. An advance notification letter may increase adherence, however, no population-based randomized trials have been conducted to provide evidence of this.
In 2008, a representative sample of the Dutch population (aged 50-74 years) was randomized. All 2493 invitees in group A were sent an advance notification letter, followed two weeks later by a standard invitation. The 2507 invitees in group B only received the standard invitation. Non-respondents in both groups were sent a reminder 6 weeks after the invitation.
The advance notification letters resulted in a significantly higher adherence (64.4% versus 61.1%, p-value 0.019). Multivariate logistic regression analysis showed no significant interactions between group and age, sex, or socio-economic status. Cost analysis showed that the incremental cost per additional detected advanced neoplasia due to sending an advance notification letter was € 957.
This population-based randomized trial demonstrates that sending an advance notification letter significantly increases adherence by 3.3%. The incremental cost per additional detected advanced neoplasia is acceptable. We therefore recommend that such letters are incorporated within the standard CRC-screening invitation process.
筛查的人群获益不仅取决于检测的有效性，还取决于依从性，而结直肠癌（CRC）筛查的依从性仍然较低。预先通知信可能会提高依从性，但是，尚未进行基于人群的随机试验来提供这方面的证据。
2008 年，对荷兰代表性人群（年龄在 50-74 岁）进行了随机分组。A 组中的所有 2493 名受邀者都收到了预先通知信，两周后再收到标准邀请。B 组中的 2507 名受邀者仅收到标准邀请。两组中的未回复者在邀请后 6 周都会收到提醒。
预先通知信导致依从性显著提高（64.4%比 61.1%，p 值<0.019）。多变量逻辑回归分析显示，组与年龄、性别或社会经济地位之间没有显著的相互作用。成本分析表明，由于发送预先通知信而导致每增加一个检测到的高级肿瘤的增量成本为 957 欧元。
这项基于人群的随机试验表明，发送预先通知信可使依从性显著提高 3.3%。每增加一个检测到的高级肿瘤的增量成本是可以接受的。因此，我们建议将此类信件纳入 CRC 筛查的标准邀请流程中。
