Organized Breast Cancer Screening Programs in Canada

1999 and 2000 Report

Recruitment and Retention

Organized breast cancer screening programs promote participation through a variety of recruitment methods. All use letters of invitation to reach at least part of their target population. However, not all programs have access to population-based lists, which may contribute to lower participation rates. Other means of recruitment include physician referrals, media campaigns and referrals from women themselves. Many programs have undertaken specialized recruitment efforts to reach underserved communities¹². 

Maintaining ongoing participation of women in a program is not only important for screening success at a population level but is also an indicator of the acceptability of screening to women. In 1999-2000 76.5% of women were rescreened within 30 months, exceeding the Canadian performance target of 75%.

Over half the women screened in 1999 and 2000 were returning for screening (rescreens), this proportion ranging from 6.4% to 86.0% (Figure 6). Although program maturity appears to be the most influential factor determining the proportion of first screens versus rescreens, population age distribution, recruitment efforts and expansion strategies may influence the composition of women attending the programs as well. 

The likelihood that a woman will be rescreened within 30 months remained stable (Figure 7). The observed 76.5% retention rate for women aged 50 to 69 exceeds the national target of at least 75%. The relatively poor retention of women aged 40 to 49 might be explained by the greater proportion of first screens occurring in this group in combination with limited targeting through promotional material, mixed policies regarding screening eligibility and recall, weaker scientific evidence of the benefits of screening for women in this age group and the availability of opportunistic screening. 

Greater “slippage” – defined as the tendency to stretch out the interval between screening episodes¹³ – was observed among women screened in 1996 and 1997 relative to women screened in 1994 and 1995. This might be explained by the growing maturity of the programs: with more and more women returning to programs operating near peak capacity, the chances for scheduling delays increase. 

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