Personal contact proves key to increasing mammography compliance

More mammography facilities closed in the U.S. than opened for business between 2001 and 2004, according to a report by the Government Accountability Office released Aug. 16. The report concludes that current supply is sufficient to meet the demand, but the GAO's reason is an indictment of U.S. healthcare.

The agency notes that 33 million women received an annual screening mammogram in any given year between 2001 and 2003. Government data indicate, however, that more than twice that many women, about 68 million, were over the age of 40 in 2003 and should have at least considered obtaining a screening exam.

It's estimated that between 70% and 80% of women who should get mammograms do so. Even if this conservative estimate is accurate, seven to 10 million women who should be getting mammograms are not.

This potential, if met, might improve healthcare in the U.S., while substantially boosting demand for mammography equipment. The question is how to improve compliance.

Researchers at the University of Massachusetts in Worcester may be on the right track to finding the answer. Dr. Roger Luckmann, an associate professor of family medicine and community health, and colleagues are looking into why some women resist getting mammograms and how to convince them otherwise. What they found was encouraging.

"There are a substantial number of people who are years overdue for a mammogram who actually realized after we contacted them that they should get one," he said. "These women were very responsive to being called on the phone and briefly counseled about the important reasons for getting a mammogram. They were appreciative when we set up a program that allowed them to get a mammogram within a week or so of the telephone call."

DI SCAN discovered the research, part of a study sponsored by the National Institutes of Health, by searching a database that consolidates information about NIH grants. The study, aimed initially at understanding the reluctance of mammogram-resistant women, led Luckmann and colleagues to develop a model intervention, involving a structured approach to increasing compliance with letters from doctors and telephone discussions of the benefits of mammography.

A pilot study identified 100 women as "mammogram resistant" based on their enrollment in insurance plans and the lack of any record of their having obtained a mammogram for at least two years. Of these women, 25 responded positively to prompting from the research team. Early data indicate that almost all of these 25 women scheduled a mammogram and followed through.

"We had no idea if we would be able to do anything at all, and we found out that perhaps as many as 25% of the women in the group are amenable to getting a mammogram," Luckmann said.

The researchers will now try to determine what convinced the women to obtain a mammogram, be it counseling, the doctor's letter, the availability of immediate scheduling, or some combination. The goal is to devise a model intervention, which will then be tested in a randomized controlled trial. There may be several factors outside the control of research team, however.

A key consideration of mammography-resistant women, found during the early research stages, may be availability of a mammography facility. If facilities are too far away, women are less likely to visit them, Luckmann said. To increase compliance with screening guidelines, therefore, healthcare officials might have to increase access to this modality either through fixed or mobile facilities. Another key consideration may be wait time.

"It could be that one of the more critical things is being able to get a mammogram within a week or two," Luckmann said. "Another is having facilities that are patient-friendly and readily available. If the center is a 50-mile drive away, you have a pretty big barrier."

If further research finds that these conditions must be satisfied to overcome resistance, and that interventions can convince women to schedule mammograms, equipment manufacturers' arguments for more widespread use of their products could be strengthened.