Personalized Approach Increases Breast Cancer Screening Rates

Women are more likely to start getting regular mammograms if health information is tailored to their personal concerns, according to the results of a Brown University study.

In this randomized clinical trial of nearly 1,400 women in Massachusetts and Rhode Island, researchers found that a personal approach encouraged more women to get a repeat mammogram than did generic advice or no intervention. Health psychologist William Rakowski, PhD, associate professor of community health at Brown University School of Medicine, and his colleagues presented their findings at a recent meeting of the Society of Behavioral Medicine.

They reported that about 60% of US women over 50 years old have had a mammogram and clinical breast examination within the last year or two, but 20% have never had one. This study tested a new way to encourage women to have mammograms on a regular basis.

Study Design

In the 4-year screening project, women recruited from a health maintenance organization were randomly assigned to three groups. All of the women 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 computer-generated, personalized letters plus information tailored to their survey responses. A second group received standard educational information, and the third group received nothing.

Women who received personalized materials were 10% more likely to get a repeat mammogram than were those who received none--a significant difference and one that applied regardless of age, race, income, and education.

Four Steps to Changing Behavior

This personalized approach to changing health behavior presumes that people go through a series of four steps before adopting a new health habit and that all people are not equally ready to change their behavior. The four steps are: precontemplation, contemplation, action, and maintenance. Relapse is possible during any of these steps.

"We match the materials to the person with the objective of nudging them one step further, rather than asking them to make a full-fledged change right away," said Dr. Rakowski.

In the study, "precontemplation" women, for example, who had not considered mammography received materials encouraging them to contemplate the screening test, while "action" women, who were beginning to have regular mammograms, were given different information to help them maintain their good screening habits. The screening project was funded by the National Cancer Institute.

Smoking and Mammography

In related research, Dr. Rakowski and colleagues also reported 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% less likely to have been screened for breast cancer than were nonsmoking women," said Dr. Rakowski says. Furthermore, nonsmoking women who lived with a smoker were about 10% less likely to get mammograms than were women who lived in nonsmoking households, added behavioral scientist Melissa Clark, PhD, an assistant professor in the Gerontology and Health Care Research Center at Brown School of Medicine.

"Our intention is not to place more blame or raise more guilt in the minds of smokers," said Dr. Rakowski. "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."

Drs. 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 check-ups, and the results were independent of age, race, income, and education. The smoking study was funded by the Robert Wood Johnson Foundation.