The proposed research submitted by SUNYSB is part of a larger interactive grant aimed at increasing breast cancer screening among women who underuse mammography. The Interactive collaborators include the Fox Chase Cancer Center, Fred Hutchinson Cancer Research Center, University of Massachusetts and University of California at Los Angeles, all members of the NCI Breast Cancer Screening Consortium. The overall aims of the interactive application are to compare the effectiveness of Barrier- Specific Telephone Counseling (BSTC) in 5 regions of the U.S. and to assess the cost-effectiveness of the intervention in increasing screening among study women. The SUNYSB project will target community women aged 50-80 who are identified through telephone surveys as under-utilizers of regular mammography. Low-income, minority and elderly women are overrepresented among such under-utilizers. The samples of women will be drawn from four study communities on Long Island. BSTC will be an intervention that is common to all Consortium sites. The SUNYSB project will also test an individualized-stepped continuing medical education (ISCME) intervention involving progressive levels of mail, telephone and in-office interventions based on the physicians' level of compliance with national guidelines for breast screening. Physicians will be classified into full, partial, or poor-compliers based upon responses to baseline surveys of over 900 primary care physicians in the study communities. The in-office intervention is designed to improve the use of office systems and to develop skills in clinical breast examination (using the MammaCare approach) and communication (using standardized patients). The ISCME intervention will be limited to under-utilizer women's physicians who are classified as partial or poor compliers. The research involves a factorial design to test the relative effects of BSTC and of ISCME when applied alone and in combination on increasing regular mammography use 1350 underuser women with partial or poor complying physicians will be randomized to the four study arms. An additional 600 underuser women with full complying physicians will also be randomized to either a BSTC or control condition. Pre- and post-intervention telephone surveys (using core items adopted by the 5 collaborating institutions) will assess women's knowledge, beliefs and practices. The research focuses on the important question of how to motivate underusers to participate in regular breast screening. The results should have wide generalizability since the research is being conducted in 5 settings across the country with a range of comparisons across various delivery settings and populations.
