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The Effectiveness of Interventions To Promote Mammography among Women with Historically Lower Rates of Screening

Mathematical Statistician, Statistical Research and Applications Branch, Surveillance Research Program [J. L.], Applied Cancer Screening Research Branch, Behavioral Research Program [H. I. M.], Applied Research Program [N. B.], Applied Cancer Screening Research Branch, Behavioral Research Program [V. C.], and Division of Cancer Control and Population Sciences [B. K. R.], National Cancer Institute, Bethesda, Maryland 20892, and Department of Community Medicine, West Virginia University, Morgantown, West Virginia 26505 [C. C.]

This study examines mammography-enhancing intervention studies that focus on women in groups with historically lower rates of mammography use than the general population. These groups consist of women who are disproportionately older, poorer, of racial-ethnic minorities, have lower levels of formal education, and live in rural areas. We refer to them as diverse populations. The purpose of this report is to determine which types of mammography-enhancing interventions are most effective for these diverse populations. For this report, United States and international studies with concurrent controls that reported actual receipt of mammograms (usually based on self-report) as an outcome were eligible for inclusion. Intervention effects were measured by differences in intervention and control group screening rates postintervention and were weighted to reflect the certainty of each study’s contribution. These effects differed significantly (Q = 218, 34 df), and the variation between studies was best explained by indicators of the use of access-enhancing approaches. Combined intervention effects were estimated for different categories of intervention types using random effects models for subgroups of studies. The strongest combination of approaches used access-enhancing and individual-directed strategies and resulted in an estimated 27% increase in mammography use (95% confidence interval, 9.9–43.9, nine studies). Additionally impressive was the access-enhancing and system-directed combination (20% increase and 95% confidence interval, 8.2–30.6, five studies). Access-enhancing strategies are an important complement to individual- and system-directed interventions for women with historically lower rates of screening.

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