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High-grade abnormalities (moderate, severe or worse) (%)1.7% (0.1-3.4) 3.4% (1.7-5.1) 1.2% (0.4-2.0) 2.0% (1.3-2.7) 0.7%

Objective To describe how three English breast screening services responded to the 2018 Patient Notification Exercise, a national intervention whereby women who had potentially missed their final screening invitation were offered new appointments. To compare key performance indicators for women thus invited with key performance indicators for women invited routinely in the same period. Methods Uptake, assessment and cancer detection for 9439 women aged over 70 in the Patient Notification Exercise were compared with key performance indicators for 14,824 women, of similar age, who were routinely invited in the same period, using chi squared ( χ2) tests. Invitation cancellation and attendance levels were also compared. Results Uptake was significantly lower among Patient Notification Exercise women sent a new, timed appointment than for women who were routinely invited (67.3% and 70.8%, respectively, p = 0.001). Assessment rates were higher for Patient Notification Exercise women (5.2% vs. 4.4%, p = 0.192) as were cancer detection rates (1.87% vs. 1.28%, p = 0.080). Services achieved national round-length standards for routine invitations during and after the Patient Notification Exercise but screen-to-assessment standards were breached (80%) in the smallest service. More Patient Notification Exercise women than routinely invited women rebooked appointments (43.6% and 33.2%, respectively); they were also slightly more likely to miss their appointments (24.5% vs. 21.2%). Conclusions Screening invitation performance can be maintained whilst responding to an additional demand of ∼5%. Larger services that cover a compact geographical area may find it easier to respond. Women affected by the incident are not more likely to attend but may require relatively more assessment capacity in incidents where invitations have been delayed.