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Results of a Controlled Clinical Trial

Nancy C. Dolan, MD; Mary McGrae McDermott, MD; Monica Morrow, MD; Luz Venta, MD; Gary J. Martin, MD

Arch Intern Med. 1999;159:393-398.

Background  We conducted a prospective controlled clinical trial in an urban academic general medicine practice to test the effect of same-day mammography availability on adherence to physicians' screening mammography recommendations.

Patients and Methods  Participants were a consecutive sample of 920 female patients aged 50 years or older who had received a physician's recommendation for screening mammography at an office visit and had no active breast symptoms, history of breast cancer, or a mammogram within the previous 12 months. Women were assigned to same-day screening mammography availability (intervention group) or usual screening mammography scheduling (control group).

Main Outcome Measures  Three-, 6-, and 12-month rates of adherence to physicians' recommendations for screening mammography.

Results  Twenty-six percent of women in the intervention group obtained a same-day screening mammogram. At 3 months, 58% of the women in the intervention group underwent the recommended screening mammography compared with 43% of the women in the control group (P<.001), increasing to 61% and 49% at 6 months (P<.001), and 268 (66%) of 408 vs 287 (56%) of 512 at 12 months (P = .003). The difference between the intervention and control groups 3-month adherence rates was most marked among women aged 65 years or older (58% vs 34%; P<.001), women who were not employed (54% vs 36%; P<.001), and women with a history of having had either no mammograms (39% vs 20%; P = .02) or only 1 to 2 mammograms (57% vs 38%; P<.001) within the last 5 years.

Conclusions  Same-day mammography availability increased 3-, 6-, and 12-month screening mammography adherence rates in this urban academic general medicine practice. The effect was most marked among women aged 65 years or older, women who were not employed, and those who had had fewer than 3 mammograms in the last 5 years. The efficacy of this intervention in other settings still needs to be demonstrated.

From the Division of General Internal Medicine (Drs Dolan, McDermott, and Martin), Departments of Preventive Medicine (Dr McDermott), Surgery (Dr Morrow), and Radiology (Dr Venta), Northwestern University Medical School, Chicago, Ill.

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