Personal Approach Works To Increase Breast Cancer Screening Rates

March 27, 1998

Women are more likely to start getting regular mammograms if health information is tailored to their personal concerns, according to a Brown University study of nearly 1,400 women in Massachusetts and Rhode Island. The findings may lead to early detection and treatment of breast cancer in more women. NEW ORLEANS -- A good way to get a woman into the mammogram habit is to address her individual concerns, say Brown University researchers.

In a randomized clinical trial of nearly 1,400 women in Massachusetts and Rhode Island, a personal approach encouraged more women to get a repeat mammogram than did generic advice or no intervention, says health psychologist William Rakowski, associate professor of community health at the Brown University School of Medicine. He and his colleagues will present the new findings on Friday, March 27, 1998, at the Society of Behavioral Medicine meeting in New Orleans.

Nationally, about 60 percent of U.S. women over age 50 report having received a mammogram and clinical breast exam in the last two years, but 20 percent have never had even one. This study aimed to test a new way to encourage and sustain regular mammography, a specialized X-ray recommended once every one or two years for women over 50 and perhaps as young as 40.

In the four-year screening project, women recruited from a health maintenance organization were randomly assigned to three groups. Women in all three groups were interviewed four times to assess their breast cancer screening history, concerns and actions. After each of the first two interviews, women in one group were sent three-page, computer-generated personalized letters and information tailored to their responses to a 35-question survey. Another group received standard educational information. The third group received nothing.

Women who received personalized materials were 10 percent more likely to get a repeat mammogram than those who received none, a significant difference and one that cut across lines of age, race, income and education.

The researchers tested a personalized approach to changing health behavior. It presumes that people go through a series of steps on their way to adopting a new health habit and that all people are not equally ready to change their behavior. Researchers have identified four steps toward adopting the mammography habit: precontemplation, contemplation, action and maintenance. A relapse can occur anytime in the health habit change process.

"We match the materials with the person with the objective of nudging them one step further, rather than asking them to make a full-fledged change right away," says Rakowski, who is considered a leader in tailoring interventions to increase mammography rates.

In the study, for example, "precontemplation" women who had not considered mammography received materials encouraging them to contemplate the screening test. On the other hand, "action" women who were beginning to have regular mammograms needed other information to help them maintain their good screening habits.

At last year's behavioral medicine meeting, Rakowski and his colleagues showed similar results with tailored interventions aimed at prompting women to get their first mammograms. The screening project was funded by the National Cancer Institute.

In other research to be presented at a Friday poster session of the meeting, Rakowski and colleagues found that smoking seems to be a barrier to regular breast cancer screening.

For some reason, women who smoked one pack or more a day were about 9 percent less likely to have been screened for breast cancer than nonsmoking women, Rakowski says. And nonsmoking women who lived with a smoker were about 10 percent less likely to get mammograms than women who lived in nonsmoking households, reports behavioral scientist Melissa Clark, an assistant professor in the Gerontology and Health Care Research Center at the Brown School of Medicine.

"Our intention is not to place more blame or raise more guilt in the minds of smokers," Rakowski says. "Until we know why this is happening, it's important for clinicians to be aware of the breast cancer screening status of women who smoke."

Rakowski, Clark and colleagues found the association between smoking and mammography rates in data from the National Health Interview Survey, a representative sampling of the country's health. The annual sample sizes ranged from 2,700 to 9,800 women. The researchers included only women who had had recent medical checkups, and the results were independent of age, race, income and education. The smoking study was funded by the Robert Wood Johnson Foundation.
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Brown University

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