Family Physician–Signed Reminder Letters Improve Return Rates for Women Overdue for Screening Mammography
A large study conducted through the BC Cancer Agency in British Columbia, Canada, reports that adding family physician–signed reminder letters to the standard schedule of postcard reminders substantially improves return rates for screening among women who are overdue for such screening. In a 6-month period, 22% of women who received only postcards returned for screening, compared to 33% of those who received postcards and letters. The findings, which were presented at a presscast in advance of the 2014 Breast Cancer Symposium, suggest that women are more likely to return for screening if they receive a personalized reminder from their family physician (Abstract 1).
“For screening mammography to be effective, women have to come for their screening appointments at the recommended intervals,” said lead study author Elisa Chan, MD, who worked for the BC Cancer Agency during the study and is now a radiation oncologist at Saint John Regional Hospital in New Brunswick, Canada, and Assistant Professor at Dalhousie University. “This study shows that for women who are overdue, even though we’ve sent them reminder postcards, a very simple intervention from their family physician can make a big difference in improving the overall screening mammography return rate.”
In Canada, breast screening mammography guidelines vary slightly by province. In British Columbia, it is recommended that women age 50 to 74 without symptoms undergo screening mammography every 2 years. This is consistent with recommendations of the U.S. Preventive Services Task Force, although some organizations recommend starting at an earlier age and/or screening more frequently.
Study Details
The BC Cancer Agency’s Screening Mammography Program sends a series of scheduled postcard reminders to women who are due for screening. This approach results in a 54% on-time screening rate among women age 50 to 69.
In this study, researchers identified 5,385 women from the Screening Mammography Program age 52 to 74 who had a prior normal screening mammography result and were overdue for screening by 30 to 48 months. The women were randomly assigned to receive the standard postcard reminders or postcard reminders plus a reminder letter personally signed by their family physician (822 physicians participated in the study). Age, number of prior screenings, and length of time overdue were not significantly different between the two study groups.
Within 6 months, 600 (22%) women in the postcard-only group returned for screening, compared to 894 (33%) women in the postcard and letter group. For women who had more than one prior screening mammography, the odds of returning for screening were 2.2 times larger than the odds for those who had undergone screening mammography only once before. Also, for women who were overdue for a shorter period of time (30 to 36 months), researchers found that the odds of returning for screening were 2.4 times larger than the odds for those who were overdue for a longer time (42 to 48 months).
Simple Intervention Yields Improved Results
Dr. Chan remarked that compared to some other methods, such as telephone reminders, the physician letter approach identified by the BC Cancer Agency Screening Mammography Program is less time-consuming and resource-intensive. Physician letters are probably effective because women typically have a trusting and long-term relationship with their family doctor, she notes. Other screening programs might consider adopting a similar strategy to improve compliance with screening mammography recommendations.
“So frequently, focus is placed on technology advancements in imaging as a method to improve breast cancer screening detection rates,” said Julia White, MD, Breast Cancer Symposium News Planning Team member. “In contrast, this study highlights how detection by screening may be improved by simply using a reminder to women with a more personal touch.”
This research was supported by the Canadian Breast Cancer Foundation, BC/Yukon Division and the BC Cancer Agency. For full disclosures of the study authors, visit abstracts.asco.org.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
