Opportunity

Breast cancer is a leading cause of cancer-related deaths among women in the United States, and breast cancer mortality is especially high for Black women. Detecting and treating breast cancer early improves survival, but screening rates have fallen short of national targets. Additionally, at the time the centralized outreach program was initiated, mammogram screening rates had not yet fully rebounded from drops due to the COVID-19 pandemic.

Intervention

Building on the pilots of the Cancer Screening Resurgence project, we partnered with Penn Medicine Primary Care to launch a centralized outreach program to raise mammography rates among patients eligible for a screening. Outreach efforts used behaviorally based tactics that lower the effort needed, change how information is presented, and provide nudges to steer patients toward getting screened. 

Beginning in late 2021, we conducted two pragmatic clinical trials to test several interventions in more than 24,000 primary care patients. Trial A tested whether providing patients with signed bulk mammogram orders – as opposed to instructions to request an order – and/or text message reminders changed completion rates. Trial B tested the effect of text message reminders and/or an endorsement letter signed by the patient’s primary care clinician. 

Impact

The studies showed that mammogram completion rates within three months were significantly higher when the bulk ordering (by 2.6 percentage points) or text messaging interventions (by around 2 percentage points) were used. The endorsement letter increased participation by about 1 percentage point, but it was not statistically significant.

Among Black women in trial A, only bulk ordering yielded a significant increase in screening completion rates.

The outreach program with text messaging is now implemented across most Penn Medicine Primary Care sites, leading potentially to hundreds more patients being screened each year and to more breast cancer cases being caught and treated earlier. Overall screening rates have increased by at least 5 percentage points since the nadir during the pandemic.