IMPACT OF A MAILED INTERVENTION ON ANNUAL MAMMOGRAPHY AND PHYSICIAN BREAST EXAMINATIONS AMONG WOMEN AT HIGH-RISK OF BREAST-CANCER

Only a few studies have examined repeat annual mammography rates, and most studies find that such regularity is low, ranging from <5% in the general population to between 14 and 20% of first-degree relatives. T he present study tested the effectiveness of a mailed intervention des igned to improve compliance with breast cancer screening guidelines am ong women at elevated familial risk. The study used a pretest-posttest control group design; 369 twin sisters of breast cancer cases were as signed alternately to an intervention or a control group on the basis of sequential registration numbers. The intervention consisted of writ ten materials, an audiotape, and mailed reminders. The posttest was ma iled 2.5 years after the intervention in order to provide adequate tim e to assess the regularity of screening. The intervention and control groups were virtually identical with respect to demographic and baseli ne screening characteristics. Of those who returned the follow-up ques tionnaire, annual physician breast examinations were 12.8% higher and annual mammograms were 10.3% higher in the intervention group than in the control group. The probability of annual screening with physician breast examination and mammography was higher in the intervention grou p, and the probability of annual mammography continued to be higher fo r women over age 52 years after controlling for baseline screening, ye ar of diagnosis, education, and status of the twin. This result is con sistent with improvements found in other studies. Women who did not re turn follow-up questionnaires were more likely to have had fewer physi cian breast examinations and mammograms and more likely to be in the i ntervention group than those who stayed in the study. Additionally, th ose who dropped out of the intervention arm perceived themselves to he less susceptible and perceived screening to be less effective than di d those who dropped out of the control arm. Although the intervention caused many women to be screened more regularly, those who had not bee n screened in the past and those who held opinions that were not condu cive to screening were more likely to drop out. This mailed interventi on for high-risk women increased their rate of screening. Characterist ics of women resistant to such programs have been identified; alternat ive strategies need to be developed to reach this small percentage of high-risk women who ignore their elevated susceptibility.