We undertook this study to test whether progressive intervention would
increase the use of mammography. In 1995, we randomly assigned into 2
groups 717 underserved women veterans in the Veterans Affairs Pale Al
to (California) Health Care System (VAPAHCS) who earned less than $22,
000 a year. The women were sent an informational letter and brochure e
xplaining why mammography is needed and how often. The letter further
requested that if the woman was due for a screening mammogram or if a
lump or other recent change in her breast had occurred, that she call
for scheduling of a free mammogram and a visit to the breast clinic. W
omen in group I (n = 351) received no further intervention. Women in g
roup II (n = 366) received a follow-up phone call by a breast care nur
se if they had not responded within 45 days of the informational maili
ng. The nurse talked to each woman about her particular needs, explain
ed to her that the screening mammogram would be provided free of charg
e, and discussed transportation arrangements to the mammography facili
ty. A total of 17 women in group I had mammograms versus 100 in group
II during the same time period. We conclude that the additional interv
ention of a phone call by a breast care nurse increased use by more th
an 5-fold, which reached significance (P < .01).