Family physicians' initiative to increase compliance with screening mammography - An innovative community project

Background: Breast cancer is the most common malignancy among women in Israel and throughout the world. Israeli omen aged 50-75 years are advised to undergo a mammographic screening examination every 2 years. However, the lack of a structured referral system is reflected in the low utilization rate of mammography. Objectives: To describe an innovative program in which family physicians in an urban clinic developed a model framework for referrals, coordinated with radiologists and surgeons, aimed at increasing compliance among women referred for mammography. Methods: A community-based study was conducted, outside of the regular reception hours, in a neighborhood practice with a population of 527 women aged 50-75. A referral system under the supervision of family physicians was designed, and the women received appointments for mammography at specified days and hours. The results of the exam! nation were sent to the physician who used dedicated time to continue the diagnostic and/or therapeutic process, as appropriate. At the physician's instructions a research assistant contacted the women who did not keep their appointments, and scheduled a second appointment. Results: In 1993, the year prior to the study, when women referred themselves for mammography, the utilization rate was 9%. During the study year the utilization rate was 77%. Women born in Europe or America had higher compliance rates than women born in Asia or Africa (81% vs. 72%, respectively). Married women were more compliant than unmarried women (81% vs. 70%, respectively). No correlation was found between compliance and age, family history of cancer in general, or breast cancer in particular. Six new cases of breast cancer were detected. Conclusions: The initiative of family physicians increased the utilization of mammography among women under their care. Family physicians allocated time outside of their regular reception hours for the program. A relatively large number of new malignancies were found, but this impression should be confirmed or negated by a large-scale study using the same methods.