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Impact of scheduled appointments on cervical screening participation in Norway: a randomised intervention
  1. Stefan Lönnberg1,
  2. Trude Andreassen1,
  3. Birgit Engesæter1,
  4. Rune Lilleng2,
  5. Cecilia Kleven3,
  6. Annelie Skare3,
  7. Karin Johansson3,
  8. Christina Stangeland Fredheim4,
  9. Ameli Tropé1,5
  1. 1Cancer Registry of Norway, Oslo, Norway
  2. 2Department of Pathology, Vestre Viken Hospital Trust, Drammen, Norway
  3. 3Oslo Jordmor og Kvinnesenter AS, Oslo, Norway
  4. 4Kråkerøy Legesenter AS, Fredrikstad, Norway
  5. 5Department of Gynaecologic Oncology, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
  1. Correspondence to Dr Stefan Lönnberg; stefan.lonnberg{at}


Background The main barrier to optimal effect in many established population-based screening programmes against cervical cancer is low participation. In Norway, a routine health service integrated population-based screening programme has been running since 1995, using open invitations and reminders. The aim of this randomised health service study was to pilot scheduled appointments and assess their potential for increased participation.

Methods Within the national screening programme, we randomised 1087 women overdue for screening to receive invitations with scheduled appointments (intervention) or the standard open reminders (control). Letters were sent 2–4 weeks before the scheduled appointments at three centres: a midwife clinic, a public healthcare centre and a general practitioner centre. The primary outcome was participation at 6 months of follow-up. Secondary outcomes were participation at 1 and 3 months. Risk ratios (RRs) overall, and stratified by screening centre, age group and previous participation, were calculated using log-binomial regression.

Results At 6 months, 20% of the 510 women in the control group and 37% of the 526 women in the intervention group had participated in screening, excluding 51 women in total from analysis due to participation just before invitation and therefore not yet visible in the central records. The RR for participation at 6 months was 1.9 (95% CI 1.5 to 2.3). There was no significant heterogeneity between centres or age groups. Participation increased among women both with (RR 1.7; 95% CI 1.4 to 2.1) and without (RR 3.5; 95% CI 1.3 to 9.2) previous participation. The RRs for participation at 1 and 3 months were 4.0 (95% CI 2.6 to 6.2) and 2.7 (95% CI 2.1 to 3.5), respectively.

Conclusions Scheduled appointments increased screening participation consistently across all target ages and screening centres among women overdue for screening. Participation increased also among women with no previous records of cervical screening.


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  • Contributors SL and TA conceived and designed the overall concept. AT, SL, CK, AS, KJ and CSF developed the practical aspects, final design and protocols. BE, TA, CK, AS, KJ, CSF and RL contributed to data acquisition. SL and BE analysed the data, and TA and AT reviewed the analyses. SL wrote the first draft of the manuscript. All authors revised the manuscript critically for important intellectual content, and gave final approval of the version to be published. SL is the guarantor.

  • Funding This pilot was financially supported by the Norwegian Cancer Society (14/00100-1).

  • Disclaimer The supporting institution did not have any role in the design, analysis or interpretation of results.

  • Competing interests None declared.

  • Ethics approval Cancer Registry of Norway, Oslo University Hospital.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Researchers interested in the anonymised individual data can contact the corresponding author for details.