Screening HMO women overdue for both mammograms and pap tests

Prev Med. 2002 Jan;34(1):40-50. doi: 10.1006/pmed.2001.0949.


Background: Regular screening has the potential to reduce breast and cervical cancer mortality, but despite health plan programs to encourage screening, many women remain unscreened. Tailored communications have been identified as a promising approach to promote mammography and Pap test screening.

Methods: The study used a four-group randomized design to compare with Usual Care the separate and combined effects of two tailored, motivational interventions to increase screening-a clinical office In-reach intervention and a sequential letter/telephone Outreach intervention. Subjects were 510 female HMO members ages 52-69 who had had no mammogram in the past 2 years and no Pap smear in the past 3 years. Primary outcomes were the percentage of women in each condition who received a mammogram, a Pap smear, or both screening tests during the 14-month study period.

Results: Thirty-two percent of the Combined group, 39% of the Outreach group, and 26% of the In-reach group obtained both services versus 19% of Usual Care participants. Overall, compared with Usual Care, both Outreach (P = 0.006) and Combined (P = 0.05) screened significantly more women. For subjects ages 65-69, Outreach rates were lower than those of Usual Care.

Conclusion: A tailored letter-telephone Outreach appears to be more effective at screening women ages 52-64 than a tailored office-based intervention, in large part because most In-reach women did not have clinic visits at which to receive the intervention.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Aged
  • Breast Neoplasms / diagnostic imaging
  • Breast Neoplasms / prevention & control
  • Community-Institutional Relations
  • Data Collection
  • Female
  • Health Maintenance Organizations / statistics & numerical data*
  • Humans
  • Logistic Models
  • Mammography / statistics & numerical data*
  • Mass Screening / statistics & numerical data
  • Middle Aged
  • Oregon
  • Papanicolaou Test*
  • Patient Acceptance of Health Care / statistics & numerical data*
  • Reminder Systems*
  • Uterine Cervical Neoplasms / diagnosis
  • Uterine Cervical Neoplasms / prevention & control
  • Vaginal Smears / statistics & numerical data*
  • Washington
  • Women's Health*