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Cancer Control Research

Sharp, Penny C.


ABSTRACT=Both incidence and mortality from breast cancer increase rapidly after age 40, and the largest increase in both incidence and mortality occurs for women over 60. However, older women are least likely to be screened. The proposed study will test the efficacy of a program conducted through primary-care practices to increase mammography screening among urban and rural women age 65 and older. The study will employ a randomized design in which 50 primary-care practices will be randomized to intervention and control groups. The intervention practices will receive a program to increase screening mammography among women age 65 and older who are not current in their screening, defined as no mammogram for at least 18 months prior to being enrolled in the study. The initial step in the study will be to identify potential barriers to screening mammography for both physicians and older women who are not current in their screening. These barriers will be addressed through informative and persuasive messages that will be delivered in three phases, at four month intervals. The first phase will identify primary-care physicians concerns about mammography screening for older women, and test the efficacy of a low-impact intervention that will address physician barriers to screening older women, as well as providing them with information which they can use to address the concerns of their patients. The second phase will provide older women with information specific to their concerns about mammography screening, and highlight for them that Medicare now pays for annual screening. The third phase will test the value of an easily learned telephone counseling approach that can be implemented in a primary-care practice. Evaluation of the intervention's effectiveness will be through medical record reports of mammography screening, and pretest/posttest interviews with women in the study population. The study will test the value of simple, inexpensive educational interventions in a sequential design that will allow examination of the relative effectiveness of each stage of the intervention as a means of increasing mammography screening among older women.

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