对于错过第一次乳腺钼靶筛查的女性，医生往往不再明确第二次乳腺钼靶筛查的日期和时间。但是英国发现，要求未参加第一次乳腺钼靶筛查女性在规定的日期、规定的时间进行第二次乳腺钼靶筛查，可以显著提高乳腺钼靶筛查的参加率！
2017年5月15日，英国《柳叶刀肿瘤学杂志》在线发表伦敦玛丽王后大学、皇家德比医院、普利茅斯医院、伦敦国王学院、谢菲尔德教学医院、皇家哈勒姆郡医院、伦敦帝国学院、查令十字医院、约克大学、曼彻斯特大学、牛津大学的随机对照研究报告，调查了未参加乳腺癌筛查者第二次定时预约的作用。该研究得到全国医保机构（NHS）资助。
由于英格兰过去十年参加乳腺癌筛查的人数不断减少，仅达全国最低标准的七成，故有必要研究并落实干预措施，以提高参加率，制止其下降势头。该研究评定了NHS乳腺筛查计划（NHSBSP）向未参加首次预约筛查者发送邀请定时预约筛查对筛查参加率的作用。
该非盲随机对照研究于2014年6月2日～2015年9月30日，在英格兰NHSBSP六个中心，将33146位未应邀参加第一次常规乳腺癌筛查的女性，按1∶1随机分配接受规定日期和时间的第二次预约邀请（干预组）或带有电话号码的邀请函以致电预订筛查（对照组）。根据SX编号（NHSBSP每位女性的顺序唯一标识号）进行随机化，在研究开始时抛硬币决定是否将SX编号为奇数或偶数的女性分入干预组。未参加第一次预约筛查的50～70岁女性符合条件进行分析。主要终点为第一次预约乳腺癌筛查后90天内的参加率，使用泊松回归来比较各组参加筛查女性的比例。所有分析均根据意向治疗。该研究注册于巴特医疗基金会，编号：009304QM。
巴特：又称巴茨，全称巴多罗买或巴塞洛缪，耶稣十二使徒之一，以其命名的皇家圣巴多罗买医院创办于1123年，是欧洲历史最久远的医院，也是英国维持原址不变时间最长的医院，虽然历经伦敦大火和伦敦大轰炸，但仍屹立不倒。1546年，亨利八世将该院移交伦敦市。1843年，圣巴多罗买医院成立医学院。1995年，圣巴多罗买医院医学院和皇家伦敦医院医学院的医科及牙科学校、护理与助产学院分别并入伦敦大学玛丽王后学院（2013年更名为伦敦玛丽王后大学）和伦敦大学城市学院。巴特及伦敦医疗基金会起初由圣巴多罗买医院、皇家伦敦医院、伦敦胸科医院组成，于2012年与威普大学十字医院和纽汉大学医院合并为巴特医疗基金会。在柯南·道尔的小说《血字的研究》中，夏洛克·福尔摩斯与华生医生即在圣巴多罗买医院的化学实验室首次相遇。在英国广播公司连续剧《神探夏洛克》第二季末集《莱辛巴赫瀑布》中，福尔摩斯即在圣巴多罗买医院顶楼一跃而下，用以影射原作《最后一案》中的莱辛巴赫瀑布。
结果，共有26054位女性符合条件进行分析，其中干预组12807位，对照组13247位。干预组与对照组相比，第一次预约后90天内的乳腺癌筛查参加率显著提高81%（参加率：22%比12%，风险比：1.81，95%置信区间：1.70～1.93，P＜0.0001）。
因此，这些研究结果表明，第二次预约规定日期和时间的措施，对于未参加乳腺筛查者，可有效改善参加率。该措施容易被筛查机构落实，如果结合简单干预，可以进一步提高参加率，并确保全国参加率趋势上移。上次参加筛查后，该措施是否应随时间而变化，有待进一步研究考虑。
对此，意大利雷焦艾米利亚医保局、圣马里亚诺瓦医院、皮埃蒙特流行病学与癌症预防中心的流行病学家发表同期评论：请勿含糊，告诉我应该何时来做乳腺钼靶筛查！
Lancet Oncol. 2017 May 15. [Epub ahead of print]
Effect of second timed appointments for non-attenders of breast cancer screening in England: a randomised controlled trial.
Prue C Allgood, Roberta Maroni, Sue Hudson, Judith Offman, Anne E Turnbull, Lesley Peacock, Jim Steel, Geraldine Kirby, Christine E Ingram, Julie Somers, Clare Fuller, Anthony G Threlfall, Rhian Gabe, Anthony J Maxwell, Julietta Patnick, Stephen W Duffy.
Queen Mary University of London, London, UK; Peel and Schriek Consulting, London, UK; Derby Teaching Hospitals NHS Foundation Trust, Royal Derby Hospital, Southern Derbyshire Breast Screening Service, Derby, UK; Hull and East Yorkshire Hospitals NHS Trust, Castle Hill Hospital, Humberside Breast Screening Service, Cottingham, UK; Plymouth Hospitals NHS Trust, Derriford Hospital, Primrose Breast Care Centre, Plymouth, UK; South East London Breast Screening Programme, King's College Hospital NHS Foundation Trust, London, UK; Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield Breast Screening Unit, Sheffield, UK; West of London Breast Screening Service, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK; Theorize, Manchester, UK; University of York, York, UK; University of Manchester, Manchester, UK; University Hospital of South Manchester, Manchester, UK; University of Oxford, Oxford, UK.
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 33146 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. 26054 women were eligible for this analysis (12807 in the intervention group and 13247 in the control group). Participation within 90 days of the first offered appointment was significantly higher in the intervention group (2861 [22%] of 12807) than in the control group (1632 [12%] of 13247); 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.
DOI: 10.1016/S1470-2045(17)30340-6
Lancet Oncol. 2017 May 15. [Epub ahead of print]
Mammography screening: please don't be vague, tell me when I should come!
Paolo Giorgi Rossi, Livia Giordano.
AUSL Reggio Emilia, Reggio Emilia, Italy; Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy; AOU Città della Salute e della Scienza, Unit of Epidemiology, CPO Piemonte, Turin, Italy.
DOI: 10.1016/S1470-2045(17)30344-3
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