Interventions to promote repeat breast cancer screening with mammography

Researchers have been trying to determine the best strategy for women who can potentially benefit from repeat mammography screening. A recent meta-analysis shows that there is no one single intervention that is best, according to a study published online June 29 in The Journal of the National Cancer Institute.

Regular mammography screening has been shown to reduce breast cancer mortality in women between the ages of 50 and 74 by approximately 23%. However, until 2001, only about half of eligible women have made use of repeat mammography screening. But the surge in recent usage of mammography (women getting them within the past two years), has far outpaced regular or repeat mammography usage. Various interventions, including educational outreach and counseling, have been tried to encourage more regular use of mammography.

To investigate the effectiveness of these intervention strategies, Sally W. Vernon, MD, of the Center for Health Promotion and Prevention Research at the University of Texas-Houston, and colleagues, looked at 25 studies that reported estimates of repeat screening for interventions and control groups. They looked at electronic databases through August 2009.

The intervention strategies used by the studies were grouped into three categories: reminders, education/motivation, and counseling. The studies were also classified according to the counseling protocols used, and whether single or multiple interventions were used.

The authors found that the studies were heterogeneous, that is, they differed in their conclusions about similar interventions. This finding could be attributed to a lack of standardization among interventions, or different populations or settings.

They noted that this meta-analysis was limited in its ability to measure the effects of interventions for repeat screening because several studies used interventions not explicitly designed to promote repeat mammography; in addition, many of the studies were conducted over ten years ago.

The authors concluded that integration of individual behavioral interventions with structural-level changes may create sustainable improvements in adherence to breast cancer screening. But more studies are needed.

"If we are to reap the benefits of mortality reduction from mammography screening, we need a better understanding of the determinants of repeat screening behavior so that we can develop more effective interventions," the authors write.

In an accompanying editorial, Dr. Jeanne Mandelblatt of Georgetown University Medical Center and Diana Buist, PhD, of the Group Health Research Institute at the University of Washington, write that one of the obstacles to defining the most effective interventions for promoting regular mammography adherence is that women may be choosing not to use mammography because of publicity about mis-diagnoses.

"It could be reasonably argued that we should better spend our efforts in discovering better early detection tests rather than continuing to invest in getting a few more women to regularly use a flawed technology," the authors write, adding that proteomics and gene expression profiling methods are two of the tools used to identify potential biomarkers for screening tests.