Enhancing mammography use in the inner city. A randomized trial of intensive case management

Arch Intern Med. 1997 Nov 10;157(20):2345-9.


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.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Breast Neoplasms / diagnostic imaging*
  • Breast Neoplasms / economics
  • Breast Neoplasms / prevention & control*
  • Cost-Benefit Analysis
  • Female
  • Humans
  • Mammography / economics
  • Mammography / statistics & numerical data*
  • Middle Aged
  • New York
  • Patient Compliance
  • Patient Education as Topic
  • Risk
  • Urban Population / statistics & numerical data*