Breast screening reminders: One size does not fit all

Results from a new paper suggest the importance of tailoring preventive health outreach, writes Kaiser Permanente’s Susan Carol Bradford

by Susan Carol Bradford, MS, Kaiser Permanente Washington manager of screening and outreach programs and clinical associate at Kaiser Permanente Washington Health Research Institute (KPWHRI)

An ounce of prevention is worth a pound of cure, but getting the right preventive care at the right time is difficult. Reminders help people stay current with scheduled preventive health services. That’s why Kaiser Permanente Washington has, for years, sent letters to members to tell them when they’re due for vaccines or cancer screening. Ten years ago, our reminder strategy changed. That gave us an opportunity to study what works best for keeping members on track with preventive care recommended by national guidelines.

We’ve had a breast cancer screening program since 1985. Originally, we sent letters to women, tailored to their age and other risk factors, when they were due for a screening mammogram. In 2007, Kaiser Permanente Washington began sending letters to members around their birthday that includes recommended preventive services for the year. Having a single annual list in a birthday letter is convenient for members, but we’re always trying to improve our outreach. So a KPWHRI team studied whether switching to annual birthday letters affected if and when women received their recommended breast screening.

Mammogram-specific letters are best, for most

We compared the two ways of letting women know they were due for breast cancer screening: a letter specifically reminding them to schedule a mammogram or including the reminder in a birthday letter. Supported by the American Cancer Society, we studied what happened when more than 151,000 birthday letters and nearly 80,000 mammogram-specific letters were mailed to women aged 40–74 years who were Kaiser Permanente Washington members between 2002 and 2012. Preventive Medicine recently published our results, summarized below, on breast cancer screening outreach effectiveness.

  • Overall, letters specifically reminding women about breast cancer screening close to when they were due were more effective than birthday letters at prompting them to get screened.
  • The effectiveness of mammogram-specific letters was most notable in women who had been getting screening according to guidelines, and who were aged 40–49 or 70–74. Timely screening dropped by more than 32 percent in the older group when they got birthday letters instead of mammogram-specific letters.
  • Some women seem to be activated by their birthday letters to get screened. For example, in women aged 70–74 who were not up-to-date on screening, nearly 23 percent went for mammograms after a birthday letter compared to about 16 percent after a mammogram-specific letter.

We concluded that mammogram-specific letters are generally a better way to remind women to stay current with recommended breast cancer screening intervals. Even if a health care system sends birthday letters about the year’s preventive health services, additional outreach timed to when services should occur could be an effective reminder. In other words, one size doesn’t fit all and personalizing outreach to individuals’ needs and preferences may be the best way to support regular preventive care.

The value of research

Our goal is to make sure women get cancer screening when the evidence indicates it is most effective for them. We’re interested in the best ways of tailoring the information, timing, and delivery method of reminders. Studies like this show the value of research for keeping Kaiser Permanente members healthy. The results support our ongoing efforts to improve the way we provide people with preventive health information they need, when they need it.

Overall, collaborations like this between Kaiser Permanente and KPWHRI are part of being a Learning Health System. Clinical partners work with researchers on designing studies and analyzing results to get practical information we might use to improve care. I’m excited to see more clinical-research partnerships developing through our new Learning Health System Program.