Bulk ordering, text messaging improve mammography completion rates

Key takeaways:

• At 3 months, bulk ordering for bilateral breast cancer screening improved mammogram completion rates.
• Women who received text message reminders had higher rates of mammography completion vs. women who did not.

Bulk ordering and text messaging outreach significantly increased completion rates for mammography breast cancer screening, according to results of two randomized clinical trials published in JAMA Internal Medicine.

“Population health approaches that involve direct outreach to patients have been shown to boost screening rates but are not widely used,” Shivan J. Mehta, MD, MBA, MSHP, associate professor of medicine at the Perelman School of Medicine and the Center for Health Care Innovation at the University of Pennsylvania, and colleagues wrote. “New insight from the field of behavioral economics have shown that humans have systematic biases, which can be leveraged to improve adherence.”

Mehta and colleagues conducted two concurrent, pragmatic, randomized clinical trials with data from 24,632 women (mean age, 60.4 years) aged 40 to 74 years from October 2021 to April 2022 to assess whether breast cancer screening rates improved with bulk ordering, text messaging and clinician endorsement. All participants were eligible for breast cancer screening and had at least one primary care visit in the past 2 years.

In trial A, 18,453 women were randomly assigned to receive an order for bilateral mammogram screening through bulk ordering, no order, an order plus text reminders or no order and no text reminders. In trial B, 6,227 women were randomly assigned to receive a portal message or letter endorsed by their clinician or from the organization, a clinician endorsed message plus text reminders or an organization message plus text reminders. Women in the text message arms received text reminders 2 weeks to 2 months after outreach.

Primary outcome was the proportion of women who completed mammography screening within 3 months of outreach.

At 3 months, in trial A, mammography completion increased with 15.4% of women who received bulk order mammogram compared with 12.7% with no order (P < .001). Mammography also increased within groups receiving concurrent text messages: 15.1% of women who received text messages completed mammography compared with 13% who did not (P < .001).

At 3 months, in trial B, mammography completion did not significantly increase among women who received clinician-endorsed messages or messages from the organization. However, mammography increased within groups receiving concurrent text messages with 13.2% of women who received text messages completing mammography compared with 10.7% who did not (P = .003).

At 6 months, 5,714 women completed mammography across both trials. Of those who completed mammography, 1.3% were diagnosed with breast cancer, of which 71.1% were early-stage breast cancer. All women with breast cancer initiated treatment.

“Future studies are needed to show how screening rates can be increased further and for repeated screening programs,” the researchers wrote.