Signed Letters From Family Physicians May Increase Mammography Screening Rates

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Women who received signed letters from their family physician along with scheduled postcard reminders are more likely to return for mammography screening than women who only received a postcard

Elisa Chan, MD

Women who received signed letters from their family physician along with scheduled postcard reminders are more likely to return for mammography screening than women who only received a postcard, according to results presented during an ASCO presscast, September 2, in advance of the 2014 Breast Cancer Symposium that will take place September 4-6 at the San Francisco Marriott Marquis.

The BC Cancer Agency, an agency of the Provincial Health Services Authority, reported that in a 6-month period, 22.3% of women who received only postcards returned for screening, compared with 33.2% of those who received both forms of outreach. Findings suggest that the personalized reminder from a family physician is a more effective way to remind women of their screening, especially if the screening is overdue.

Lead study author Elisa K. Chan, MD, a radiation oncologist who worked for the BC Cancer Agency during the study and is now at Saint John Regional Hospital in New Brunswick, Canada, said that, “a signed family physician letter sent to women who are overdue for their mammography screening is a simple and effective intervention to improve screening mammography rates compared with the standard mammography postcard.”

“The study speaks to the importance of having specialists work with primary care teams and networks so that women in the general population are getting this important access to screening mammography that they very much still need,” said Harold J. Burstein, MD, PhD, moderator of the presscast and a medical oncologist at Dana-Farber Cancer Institute and Brigham and Women’s Hospital in Boston, Massachusetts.

In the study, researchers identified women who were overdue for screening by 30 to 48 months. The 5385 women identified were randomly assigned to receive either the standard postcard reminder or postcard plus the signed letter. A total of 822 physicians participated in the Screening Mammography Campaign.

Within 6 months, 600 women (22.3%) who received only the postcard returned, while 894 women (33.2%) who received both the postcard and letter returned (odds ratio [OR] 1.7, P <.0001). The maximum difference between the screening mammography return rates was observed at 4 months. Women who were 30 to 36 months overdue were more likely to return compared with those who were 42 to 48 months overdue (OR 2.4, P <.0001). “Even though we analyzed the data at the 6-month period, there was quite a big difference between both groups even much earlier on,” said Chan, an assistant professor at Dalhousie University.

The researchers note that age, number of prior screenings, and length of time overdue were not significantly different between the two study groups.

In the breast screening program, a series of scheduled postcard reminders are sent to women who are due for screening. Typically, 2 reminder postcards are sent 5 weeks before and 5 weeks after a woman’s 2-year screening anniversary, and then another 2 postcards are sent 5 weeks before and 5 weeks after her 3-year screening anniversary if she has not made a mammogram appointment. This reminder approach results in a 54% on-time screening rate among women who are 50 to 69 years of age. “But there’s definitely room for improvement,” said Chan during the presscast.

In Canada, breast cancer screening guidelines vary by province. In British Columbia, it is recommended that women aged 50 to 74 without symptoms undergo screening mammography every 2 years. This is consistent with the United States Preventive Services Task Force recommendation, although some organizations recommend starting at an earlier age.

Compared with other outreach methods, like telephone reminders, Chan remarked that sending a signed letter was less time consuming and less resource intensive. Physician letters are probably more effective because women typically have a trusting relationship with their family doctor, according to Chan. Other screening programs might consider adopting a similar strategy to improve compliance with screening mammography recommendations.

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