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April 10, 1995

Improving Compliance With Breast Cancer Screening in Older Women: Results of a Randomized Controlled Trial

Author Affiliations

From the Department of Medicine, Division of Geriatric Medicine, University Hospitals of Cleveland (Dr Herman); Department of Medicine, Division of General Internal Medicine at MetroHealth Medical Center (Drs Speroff and Cebul) and Department of Epidemiology and Biostatistics (Drs Speroff and Cebul), Case Western Reserve University School of Medicine, Cleveland, Ohio. Dr Herman is now with the University of New Mexico, Albuquerque.

Arch Intern Med. 1995;155(7):717-722. doi:10.1001/archinte.1995.00430070071009

Background:  To compare three approaches for improving compliance with breast cancer screening in older

Methods:  Randomized controlled trial using three parallel group practices at a public hospital. Subjects included women aged 65 years and older (n=803) who were seen by residents (n=66) attending the ambulatory clinic from October 1, 1989, through March 31, 1990. All provider groups received intensive education in breast cancer screening. The control group received no further intervention. Staff in the second group offered education to patients at their visit. In addition, flowsheets were used in the "Prevention Team" group and staff had their tasks redefined to facilitate compli

Results:  Medical records were reviewed to determine documented offering/receipt of clinical breast examination and mammography. A subgroup of women without previous clinical breast examination (n=540) and without previous mammography (n=471) were analyzed to determine the effect of the intervention. During the intervention period, women without a previous clinical breast examination were offered an examination significantly more often in the Prevention Team group than in the control group, adjusting for age, race, and comorbidity and for physicians' gender and training level. The patients in the Prevention Team group were offered clinical breast examination (31.5%) more frequently than those in the patient education or control groups, but this was not significant after adjusting for the above covariates. Likewise, mammography was offered more frequently to patients in the Prevention Team and in the patient education group than to patients in the control group, after adjusting for the factors above using logistic regression.

Conclusions:  The results provide support for patient education and organizational changes that involve nonphysician personnel to enhance breast cancer screening among older women, particularly those without previous screening.(Arch Intern Med. 1995;155:717-722)