Canadian researchers found that the simple intervention of sending women a signed letter from their family physician boosted screening mammography return rates, according to a September 2 press conference held in advance of the annual American Society of Clinical Oncology (ASCO) Breast Cancer Symposium in San Francisco.
"That simple human touch increased the chance of a woman overdue for screening mammography coming back by more than half," said Dr. Harold Burstein, PhD, from Dana-Farber Cancer Institute, who facilitated the press conference. "It's a tribute to the power of the personal connection between women and their doctors."
Encouraging screening
How often women should undergo breast cancer screening -- and at what age they should begin -- is a hotly debated issue. But no matter which protocol a facility follows, a key problem remains: How can women overdue for screening be encouraged to return?
In Canada, screening mammography is recommended every two years for asymptomatic women between the ages of 50 and 74. The British Columbia Screening Mammography Program sends out multiple postcard reminders to women who are due or overdue for screening, which results in a 54% participation rate, according to study presenter Dr. Elisa Chan of St. John Regional Hospital in New Brunswick.
"We send two postcards around the two- and three-year mark, one five weeks before, and another five weeks after," Chan said. "For the subgroup of women who are already routine participants, this results in an 80% compliance rate. But the overall rate of 54% tells us there's definitely room for improvement."
Chan's team identified 5,385 women from the program ages 52 to 74 who had a prior normal mammography screen but were overdue for another by 30 to 48 months. Half of the women were randomly assigned to receive the program's standard postcard reminders, while the other half received the postcards plus a reminder letter signed by their family physician.
All family physicians in British Columbia were invited to participate, and 822 agreed, for a participation rate of 26%. Six months after the mailings, Chan's group examined the screening mammography return rate.
"Physicians were not allowed to adjust any of the text in the letter, and we provided no reminders for them to send the letters," Chan said. "The physicians received no renumeration for participating in the study."
Within six months, 600 (22.3%) of the women who received a postcard without a signature returned, while 894 (33.2%) of the women who received the postcard and the letter returned. In the postcard-plus-letter group, those who had undergone more than one prior screening mammography exam were 2.2 times more likely to return than those who had mammography screening only once before. Women who were overdue for their next screening exam by a shorter period of time (30 to 36 months) were 2.4 times more likely to return than those who were more overdue (42 to 48 months).
"Our data show that women quickly responded after receiving the letter," Chan said. "Even though we did our analysis at six months, there was a big difference in response among women who received the letter plus the postcards even earlier on."
The researchers found similar results in the following subgroups:
- Women ages 51 to 60, 61 to 70, and older than 70
- Women who had one previous mammogram
- Women who were overdue for another mammogram by 31 to 36 months, 37 to 42 months, and 43 to 49 months
This simple tactic has wide-reaching results, Burstein concluded.
"Sending women overdue for mammography a signed letter from their family physician proved to be an effective intervention," he said. "And since mammography remains an important tool for lowering mortality rates from breast cancer, it's essential that we make sure women in the general population have access to it."
