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Enhancing mammography use in the inner city. A randomized trial of intensive case management
1University of Rochester School of Medicine and Dentistry, St Mary's Hospital, Rochester, NY, USA.
Background:
Breast cancer screening with mammography is an effective intervention for women aged 50 to 75 years but it is underused, especially by the urban poor.
Objective:
To improve mammography completion rates for urban women aged 52 to 77 years who had not had a mammogram in at least 2 years.
Methods:
We conducted a randomized controlled trial of a case management intervention by culturally sensitive community health educators vs usual care in 6 primary care practices supported by a computerized clinical information system.
Results:
Women in the intervention group were nearly 3 times as likely to receive a mammogram (relative risk, 2.87; 95% confidence interval, 1.75-4.73). The benefit persisted when analyzed by age; race, and prior screening behavior. This intervention was practice based, not dependent on visits, and enhanced the efficacy of an already successful computerized preventive care information system.
Conclusions:
Personalized education and case management are successful in enhancing compliance with breast cancer screening among historically noncompliant vulnerable urban women. This intervention, when combined with a preventive care information system, has the potential to achieve Healthy People 2000 objectives for breast cancer screening.
