Doctor's 'Human Touch' Improves Mammography Screen Return

Nick Mulcahy

September 03, 2014

A signed personal letter from a family physician significantly improved the odds of a patient returning for screening mammography, according to a randomized study of Canadian women who were overdue for their biannual test.

The investigators reached out to 5385 participants in the Screening Mammography Program of British Columbia (BC), run by the BC Cancer Agency, who were up to 4 years late for their next scheduled mammogram.

The team used 2 different contact methods: a standard schedule of postcard reminders; and postcards plus a personalized letter from the woman's family physician.

In a 6-month period, fewer women who received only postcard reminders returned for screening than women who received postcards plus a letter (22% vs 33%; odds ratio, 1.7; P < .0001), investigators from the BC Cancer Agency, led by Elisa Chan, MD, report.

Dr. Chan discussed the study during a presscast held in advance of the 2014 Breast Cancer Symposium in San Francisco.

The letter is a "simple human touch," and the study results are an "extraordinary tribute to the power of personal communication," said presscast moderator Harold J. Burstein, MD, PhD, from Harvard Medical School in Boston, who was not involved in the study.

About half of all eligible women (54%) participate in the Screening Mammography Program of BC in an "on-time" fashion, Dr. Chan reported. Thus, about half are late at any point in time.

Dr. Chan and colleagues only reached out to women in the program who were very late — from 30 to 48 months — for their next screening.

The women were 50 to 74 years of age without breast cancer symptoms. It is recommended in British Columbia that such women undergo screening mammography every 2 years, which is consistent with the current recommendations of the US Preventive Services Task Force.

A total of 822 family physicians participated in the study.

The women in the 2 study groups had similar baseline characteristics, such as age, number of previous mammograms, and number of months overdue, said Dr. Chan, who is now a radiation oncologist at Saint John Regional Hospital in New Brunswick, Canada, and assistant professor at Dalhousie University in Halifax, Nova Scotia.

Getting higher return rates is one of the "challenges" in any mammography screening program, Dr. Burstein pointed out.

He noted that this study indicates that imaging specialists might need to "extend themselves" to general practitioners if they want to see higher rates of serial screening.

In a press statement, Dr. Chan observed that the physician letter approach is less time consuming and resource intensive than some other methods, such as telephone reminders.

Physician letters might be effective because women typically have a trusting and long-term relationship with their family doctor, she explained.

This research was supported by the Canadian Breast Cancer Foundation, BC/Yukon Division, and by the BC Cancer Agency. A number of authors report financial relationships with industry, including screening technology companies.

2104 Breast Cancer Symposium (BCS). Abstract 1. To be presented September 4, 2014.


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