Although many studies have focused on barriers to mammography, little attention has been given to retaining regular mammographic screening among women who already have had an initial mammogram. Yet it is among second or later screens that the earliest cancers should be found. Rescreening rates are uniformly poor for all women, regardless of race or ethnicity. An intervention trial on repeat mammography screening is proposed. It will test the hypothesis that community """"""""peer counselors"""""""" can improve rescreening rates among women over age 50 more than intervention programs that simply use follow-up letters to remind women of their appointments. The peer counselors will work with screenees to stress the importance of repeat mammography and breast self examination, as well as empower them with the skills and knowledge of how to obtain these medical services for themselves. This study will enroll approximately 2,900 asymptomatic women who have been screened through the Early Detection Program [EDP] of the University of Miami School of Medicine, in Miami, Florida. Of these, 2,000 women are expected to have """"""""negative"""""""" mammograms at their first screening, while 900 will have """"""""suspicious"""""""" findings. This program, operating since 1987, screens women on a mobile mammography van which circulates through county Primary Health Care Centers [PHCCs] on a fixed schedule. Women attending one half of the centers will receive """"""""usual"""""""" follow-up, i.e., they will be reminded of their follow-up appointment four times after their initial mammogram, as well as receive appropriate educational materials, through the mail. The second group of women will receive a more intensive educational intervention, that will consist of a one-to-one educational session with a peer counselor who reflects her community, in terms of race, language, and culture. These counselors will be recruited from their own communities to explain to screenees the importance of repeat mammograms, and breast self examination, and will seek to empower the women to develop the interpersonal skills necessary for them to demand repeat mammograms or appropriate follow-up procedures. In this second intervention, educational materials and reinforcement of the empowerment skills will also be done four times subsequent to their mammogram, but by the peer counselor. A final personal telephone call will be made to the participant one week prior to the date of the scheduled mammogram. The participant will have access to the peer counselor during the intervention. Outcomes will include rescreening rates, as well as changes in attitudes and knowledge about cancer rescreening. The successful completion of this study will have direct implications on the mammography screening programs in minority populations, and can serve as the foundation of minority programs for other diseases.
