Simple interventions may help more women receive timely breast cancer screening, according to research published on November 10 in JAMA Internal Medicine.
A study led by Soo-Chin Lee, PhD, from the National University Cancer Institute in Singapore found that sending a one-time mailed reminder to women overdue for screening increased their participation.
“Scalable strategies to reengage overdue repeat screeners are urgently needed,” Lee and colleagues wrote.
Although mammography is the gold standard for breast cancer screening, many women still do not follow recommended screening schedules. In the U.S., about 72% of women get screened, but repeat mammogram rates average just 46.1%, according to previous research.
Lee’s team tested practical behavioral interventions to improve mammogram uptake among women overdue for repeat screening. The study included 9,000 women aged 50 to 69 who had not had a mammogram in the past two years. These women were registered on a Singapore hospital’s mobile health application.
The participants were randomly assigned to five groups in a 2:1:1:1:1 ratio:
- Group 1: Personalized mailed reminder
- Group 2: Mailed reminder plus a $7.50 conditional voucher
- Group 3: Mailed reminder plus a conditional chance to win $3,750 in a lottery
- Group 4: Mailed reminder plus motivational videos
- Group 5: Mailed reminder plus a dedicated scheduling hotline
All groups also received three push notifications via the mobile app, spaced three weeks apart.
Of the total participants, 5,872 were aged 60 to 69, and 3,128 were aged 50 to 59. Older women had longer lapses in screening than younger women (7.7 years vs. 5.4 years; p < 0.001).
The cost per 1,000 women varied from $742 for Group 1 to $5,512 for Group 5. Group 5 had the highest mammogram uptake (13.8%), but this was not statistically significant compared with Group 1 (11.2%). Other groups also showed similar non-significant increases:
| Group | Uptake |
|---|---|
| 1 | 11.2% |
| 2 | 12.1% |
| 3 | 11.3% |
| 4 | 10.8% |
| 5 | 13.8% |
Women more than 10 years overdue in Groups 2 and 5 had slightly higher uptake (8.8% and 8.9%) than Group 1 (4.8%), but these differences were also not statistically significant. Digital interventions showed very low engagement, with all below 5%.
The researchers concluded that mailed reminders are an effective, low-cost strategy to improve screening. They noted that expensive interventions may not be more effective and may not be necessary for population-level programs.
In an accompanying editorial, Steven Atlas, MD, from Harvard Medical School, highlighted the importance of data from non-Western countries to guide global health initiatives. He said these findings could apply to low-, middle-, and high-income countries, including parts of Asia where organized mammography programs are limited.
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