July 14, 2009 -- Mammogram reminders, when given in a step-wise fashion that starts with mailings and ends if necessary with personal phone calls, do boost the number of women who get their routine mammograms on schedule, according to a new study.
The reminder program could save lives, says the study's lead author Adrianne Feldstein, MD, an investigator and medical liaison for research at Kaiser Permanente's Center for Health Research in Portland, Ore.
''If this was widely used we believe we would be able to detect 25,000 additional early breast cancers in the U.S.," Feldstein says of the reminder system she tested. She bases that estimate on computations such as the number of mammograms per year that lead to a new diagnosis of breast cancer.
Mammography rates have been declining in recent years, according to recent research, with 66% of U.S. women getting routine mammograms in 2005 compared to 70% in 2000.
Mammogram Reminders: Study Details
For the study, Feldstein and her colleagues compared the follow-up, routine mammogram rates of more than 35,000 women who were members of the Kaiser Permanente Northwest HMO. The reminder program of mailings and telephone calls targeted only one group of women, those aged 50 to 69.
"When it was four months before it was due, we started to remind them," Feldstein says. The goal, she says, was to encourage women to have a mammogram at least every 24 months (although some organizations urge annual mammograms).
In the other two groups were women aged 42 to 49, for whom mammograms are also recommended by the U.S. Preventive Services Task Force, one of many organizations setting guidelines, and women aged 70 and above, for whom mammograms are conditionally recommended by the task force.
Beginning in January 2006, women in the 50-69 age group coming due for a routine mammogram in four months got their first reminder, a mailed informational postcard reminding them of the need for the screening and encouraging them to make an appointment.
Women who did not make an appointment received an automated telephone reminder a month later. A month after that, women who still hadn't made an appointment got a second automated call.
Finally, at about 23 to 24 months after their last mammogram, the local health care team followed up with women who still hadn't responded, leaving up to two messages directly to the patient and asking for a callback so an appointment could be secured.
Mammogram Reminders: Study Results
Before the reminders, 63.4% of the women in the targeted group got a mammogram on schedule. By the second year of the program, the number rose to more than 80%, Feldstein says.
The women in the targeted group were 1.5 times more likely to get a mammogram after the reminder than the control group of younger women.
Mammogram Reminders: Perspective
The recent study findings seem to contradict a study, published in 2008, that found mailed mammogram reminders, even when personalized, did not make a difference. In that study, researchers divided 8,444 women aged 52 and older into three groups. One group got a packet of information about mammography in the mail; a second group got the packet and a note telling them when the next appointment was due and a newsletter about mammography. The third group received no information.
During the three-year study, all three groups had similar rates of routine follow-up mammograms.
But the recent study was different, Feldstein says, because it used such a comprehensive approach. "It's the combination that did the trick," Feldstein tells WebMD, referring to the mailing and follow-up messages, both automated and live.
Mammogram Reminders: Second Opinion
"I think this study confirms what many of us have thought and done for years," says Ellen Mendelson, MD, chief of the breast imaging section and professor of radiology at the Feinberg School of Medicine, Northwestern University, Chicago. A member of the American College of Radiology Breast Imaging Commission, Mendelson reviewed the study for WebMD.
Her department sends annual reminders, she says.
In the study, the increase in routine mammograms among targeted women from 63% to more than 80%, Mendelson says, "is really very good."