Improving Breast Cancer Screening Coverage in Primary Healthcare: A Quality-Improvement Study (2023-2025)

Organized breast cancer screening reduces mortality; however, coverage within our primary healthcare (PHC) network was substantially below benchmarks. Barriers included limited awareness, fragmented workflows, suboptimal use of electronic systems, and constrained diagnostic capacity. Screening delivery relied on opportunistic identification rather than systematic recall, resulting in missed opportunities, limited performance monitoring, and prolonged diagnostic pathways. This study aimed to increase breast cancer screening coverage among eligible women aged 40-69 years attending PHC clinics from 1.0% in August 2023 to at least 76% by September 2025 through: (1) systematic identification of eligible women using electronic health records (EHR)-based prompts and recall systems; (2) increased completion of screening mammograms; (3) timely diagnostic follow-up (≤14 days); and (4) minimal disruption to clinical workflow.

A quality-improvement (QI) initiative was conducted from August 2023 to October 2024 using the Institute for Healthcare Improvement Model for Improvement and sequential Plan-Do-Study-Act (PDSA) cycles. A multi-disciplinary team reviewed weekly and monthly reports tracking mammography requests, completions, Breast Imaging Reporting and Data System (BI-RADS) results, and waiting times. Although active implementation concluded in October 2024, outcomes were monitored through September 2025 to assess sustainability. Four PDSA cycles addressed as follows: (1) staff awareness and readiness, (2) structured patient recall using electronic health record-generated eligibility lists and outreach, (3) performance transparency via dashboards and feedback, and (4) workflow integration with periodic audits to support sustainability. The primary outcome was screening coverage. Secondary outcomes included BI-RADS distribution and confirmed malignancies. Balancing measures were mammography waiting time and physician perceptions.

Documented screening coverage increased from 1.0% (n=49) in August 2023 to 70% (n≈3,400 of 4,857 eligible women) by September 2025. During the project period, a total of 1,652 screening mammograms were completed. Among completed mammograms, 68.2% (n=1,127) were BI-RADS 1-2, 18.9% (n=312) BI-RADS 0, 11.6% (n=192) BI-RADS 3, and 1.3% (n=21) BI-RADS 4-5, yielding 11 confirmed malignancies. Waiting times improved following capacity adjustments. Physician survey responses (n=36) indicated good acceptability and perceived feasibility within routine practice.

A multi-component, data-driven QI strategy integrated into PHC workflows was feasible and associated with substantial and sustained improvement in breast cancer screening coverage while maintaining timely diagnostic follow-up.