Study objectives-To determine the relative effectiveness of three interventions designed to increase the uptake of breast screening. Design -Randomised controlled trial of a nurse visitwith health education (group A), nurse visit without health education (group B), and GP letter (group C). Setting -The area of south east London served by the Butterfly Walk Breast Screening Unit in Camberwell. Participants -Women aged between 50 and 64 years who were registered with 27 GPs in the Lambeth, Southwark and Lewisham family health services authority and who had not attended for first round screening. Main results -Altogether 799 women were randomly allocated to the three groups. In general, delivering the nurse based interventions proved difficult. In group A, 114% (95% CI 7'9, 14.9%) of women subsequently attended for screening compared with 7*8% (95% CI 5*1, 11-4%) in group B and 13-1% (95% CI 7.9, 18-4%) in group C.The differences between the groups (95% CIs) were not statistically significant: A versus C, -1-7% (-8.0, + 4-6%); B versus C, -5-3% (-11.3, +0-7%); A versus B, +3-6% (-1-0, +8X2%). Conclusions -A personal letter from the GP seems to be at least as effective at increasing the uptake of breast screening in non-attenders as a nurse making a home visit to discuss the issue ofbreast screening, and is not noticeably less effective than a visit at which a health education intervention is delivered. It is possible that the GP letter is considerably more effective than either of the two interview-based interventions. With regard to implementing strategies which will increase breast screening uptake and are cost effective, further trials ofsimilar minimal interventions in primary care are required. (JEpidemiol Community Health 1996;50:72-76) Breast cancer is the major public health problem facing women in the UK today. The latest figures show that each year nearly 30 000 women are newly diagnosed with breast cancer and over 15 000 women die from it. Overall, it is estimated that one in 12 women will develop breast cancer at some time in their life.'The National Health Service breast screening programme (NHSBSP) is based in primary care, and provides single oblique view mammography for women aged 50 to 64. Eligible women registered with a GP are called for screening every three years by the local screening unit usually on a practice list basis. It is hoped that the screening programme will contribute to a reduction in the mortality from breast cancer of 25% by the year 2000: this aim has now been incorporated as a target in the Health ofthe Nation strategy.2 It is estimated that this reduction will require 70% of the population to accept their invitations.3 Unlike cervical screening, also undertaken three yearly on the basis of a GP list, breast screening is undertaken by dedicated health professionals at special screening units and no fee is payable to the GP regardless of uptake. There is some evidence that the introduction of financial incentives for cervical screening, childhood immunisations, and mo...

In a study in which patients were allocated non-systematically to surgeries booked at 5, 7.5, and 10 minute intervals 623 consultations were taperecorded. In surgeries booked at longer intervals doctors used the extra time to take a fuller history from their patients. In surgeries booked at 10 minute intervals doctors spent more time explaining the patient's problem, explaining the proposed management, and in discussing prevention and health education, these increases not being evident in surgeries booked at 7.5 minute intervals.

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