The effect on attendance of the requirement to confirm a pre-scheduled appointment in a population-based mammography screening programme

The European Commission Initiative on Breast Cancer recommends pre-scheduled appointments to enhance attendance in population-based mammography screening programmes (PMSP). Pre-scheduled appointments often lead to no-shows, resulting in inefficient use of time and staff in screening units. Requiring women to confirm their appointments can reduce no-shows but might negatively impact attendance. We conducted a non-interventional study to assess the impact of requiring confirmation on attendance rates. The study involved 291 127 women aged 50-69 invited to PMSP between 1 June 2022 and 31 May 2023. Propensity scores were used to match women who were required to confirm their pre-scheduled appointments (exposure) 1:1 with those who were not required to confirm (comparator). This was done separately in four strata based on screening history: first-time invitees, regular attendees, irregular attendees, and non-attendees. Logistic regression with generalized estimating equations was used to analyse the effect of the exposure on attendance within 60 days, separately for each stratum. If first-time invitees were obliged to confirm their pre-scheduled appointment, their attendance was 19% lower [odds ratio (OR) 0.81, 95% confidence interval (CI) 0.76-0.86]. The impact on regular attendees (OR 0.95, 95% CI 0.92-0.99), irregular attendees (OR 0.94, 95% CI 0.89-0.99), and non-attendees (OR 0.96, 95% CI 0.90-1.01) was minimal or non-significant. Requiring confirmation poses a barrier for first-time invitees but has little effect on those with previous screening history. Limiting confirmation requirements to women with prior invitations could optimize resource use in screening units without a notable decrease in attendance rates.