Although women aged 65 and older are at increased risk for developing breast cancer and the majority of breast cancer deaths occur in older women, use of screening mammography decreases with age. Fox Chase Cancer Center and Duke Comprehensive Cancer Center are collaborating to study the impact of targeted interventions on mammography utilization among women aged 65-84 residing in retirement communities in Pennsylvania and North Carolina. The study builds upon the foundation of previous research conducted by the team which showed that a combination of educational, cost reduction, and access-enhancing interventions produced a marked increase in mammography utilization among older women (aged 65+). Forty communities estimated to have about 40 women between the ages of 65 and 84 who will not have had a mammogram within the past two years will be recruited. At least one-fifth of the communities will be predominately African American and/or lower SES.
The aims of the study are to assess the impact of separate and combined sets of interventions on mammography, the impact of the interventions on African American and/or lower SES women, the yield from screening, factors potentially related to follow-up of abnormal mammograms, as well as costs associated with delivery of the interventions. A fully factorial design is being used to compare the impact of information about the new Medicare coverage for mammography alone vs. information about mammography coverage and access-enhancing strategies (transportation to the appointment) vs. information about the new coverage and educational interventions directed at women and their physicians vs. the combination of information about Medicare coverage, access-enhancing strategies, and educational interventions. Only ACR-approved radiology practices will be used for referral, and all abnormal mammograms will be followed. To determine the effectiveness of the interventions, telephone interviews will be conducted with a random sample of women prior to intervention, and 6 months afterwards. A separate analysis will be done to examine cost. The results of the proposed study will provide policy-makers and researchers alike with information about the most effective strategies for increasing mammography use in older women.
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