A community trial to test the effectiveness of intervention strategies to improve mammography screening rates among underserved women

Underserved women have a high breast cancer mortality rate, largely attributed to their lower participation in breast cancer early detection screening programs, in addition to receiving fewer adjuvant treatments than women in the general population. A randomized community trial was conducted to find the most effective intervention strategy to improve screening mammography rates of low-income women participating in a Medicaid/ Medicare program. Three strategies were used: a) a prompter letter from their Managed Care Organization (MCO); b) a reminder letter from their primary care physician (PCP); and c) telephone and/or in home counseling. These strategies were randomly assigned to 2357 participants. A control group (n=786) received usual care with no intervention. The first group (n=785) were mailed the MCO letter; and the second group (n= 786) received the targeted MCO letter, the PCP letter, and/or counseling at sequential intervals of approximately four months. The results show that counseling was three times as likely as no-intervention to increase mammography screening (RR=3.02; P= .000001; CI: 2.10, 4.34) and about two and half time as likely as the MCO letter alone (RR=2.38; P=. 00001; CI: 1.64, 3.17). The PCP letter was 68% more likely to increase the mammography rate than the no intervention (RR=1.68; P=. 01; CI: 1.12, 2.53). The study concluded that Counseling and/or a PCP letter is most effective in improving mammography rates as compared to the MCO letter and no-intervention groups.