Published in Cancer Detection and Prevention 1998; 22(1):30-38.

Factors Affecting Participation in a Mammography Screening Program Among Members of anUrban Detroit Health Maintenance Organization

Michael S Simon MD MPHa, Phyllis A Gimotty PhDa, Jennifer Coombs MPHb, Scott McBride MAa, Anita Moncrease MDb, Robert C Burack MD MPHb

aBarbara Ann Karmanos Cancer Institute at Wayne State University, Detroit, MI; bDepartment of Internal Medicine, University Health Center-5C, Detroit, MI

Address all correspondence and reprint requests to: Michael S. Simon. M.D., M.P.H., Wayne State University School of Medicine, Harper Hospital-513 Hudson, 3990 John Rd., Detroit, MI 48201.

ABSTRACT: Breast cancer mortality rates remain disproportionately high among black women despite recent improvements in mammography screening utilization. We conducted a telephone survey among a sample of women (N = 202) participating in a randomized controlled trial investigating the effectiveness of a mammography reminder letter that was one component of a breast cancer control intervention strategy. The objectives of the survey were to ascertain the extent to which the letter reminder was received and acted upon, and to determine attitudes and breast cancer control practices in the target population. The study was conducted among members of a large health maintenance organization serving predominantly black women in Detroit, Michigan. Forty-eight percent of the participants completed a mammogram during the year after the letter was sent. While 72% of the women remembered receiving the letter reminder, only 5% responded to the recommendations in the letter. Important predictors of mammography completion included past mammogram utilization (OR: 2.49; 95% CI: 1.05-5.93), a prior physician recommendation for a mammogram (OR: 1.99; 95% CI: 1.00-3.95) and subject's knowledge of her primary physician's name (OR: 2.05; 95% Cl: 0.91-4.60). Letter reminders promoting primary care visits were relatively ineffective since few women reported being prompted by the letter recommendation. Strategies which target physician mammography referral behavior may have an important impact on mammography utilization among inner-city women.

KEY WORDS: barriers, breast neoplasms, letter reminder, mammography, screening, survey.

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