Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
Ann Acad Med Singap. 2014 Dec;43(12):588-94.
Breast cancer is the leading cancer among women in Singapore. Five years after a population-wide breast cancer screening programme was introduced, screening rates remained relatively low at 41%. Studies have shown decreased screening propensity among medically underserved women typically of minority or socioeconomically disadvantaged status. We conducted a quasi-randomised pragmatic trial aimed at encouraging mammography screening among underscreened or unscreened women in a publicly funded primary care facility in Singapore.
The study was conducted from May to August 2010. Components of intervention included (1) tailored education, (2) doctor's reminder, and (3) cost reduction. Researchers administered a structured questionnaire to eligible female polyclinic attendees and patient companions aged 40 to 69 years. Individual knowledge, attitudes, beliefs, and barriers towards mammography screening were identified and educational messages tailored. Doctor's reminder and cost reduction were implemented additively.
Overall, out of 448 participants, 87 (19.4%, 95% confidence interval (CI), 15.8% to 23.1%) completed mammography screening across 3 arms of study. Participants who received a cost reduction were more likely to attend screening compared to participants in other intervention arms (adjusted odds ratio (OR) 2.4, 95% CI, 1.2 to 4.5, P = 0.009). Cost of screening, ethnicity, prior screening history, and attitudes towards mammography screening were identified as significant factors predicting mammogram attendance.
Including a cost reduction component was the most effective intervention that increased mammography screening rates. Women's underlying beliefs, attitudes, and other predisposing factors should also be considered for integration into existing breast cancer screening programmes.
乳腺癌是新加坡女性中最常见的癌症。在引入全人群乳腺癌筛查计划五年后，筛查率仍相对较低，为 41%。研究表明，在医疗服务不足的女性中，筛查意愿降低，这些女性通常属于少数族裔或社会经济地位较低的群体。我们进行了一项准随机实用试验，旨在鼓励新加坡一家公立基层医疗保健机构中未接受或未充分接受乳腺癌筛查的女性进行乳房 X 光检查。
该研究于 2010 年 5 月至 8 月进行。干预措施包括（1）量身定制的教育，（2）医生提醒，和（3）降低成本。研究人员对符合条件的女性综合诊疗所就诊者及其年龄在 40 至 69 岁的同伴进行了结构化问卷调查。确定了个人对乳房 X 光检查的知识、态度、信念和障碍，并针对这些问题提供了个性化的教育信息。医生提醒和降低成本是依次实施的。
在 448 名参与者中，共有 87 名（19.4%，95%置信区间[CI]，15.8%至 23.1%）在研究的 3 个组中完成了乳房 X 光检查。与其他干预组的参与者相比，接受成本降低的参与者更有可能接受筛查（调整后的优势比[OR] 2.4，95%CI，1.2 至 4.5，P=0.009）。筛查费用、种族、既往筛查史以及对乳房 X 光检查的态度被确定为预测乳房 X 光检查参与的重要因素。
增加成本降低干预是提高乳房 X 光检查率的最有效干预措施。还应考虑女性的潜在信念、态度和其他倾向性因素，将其纳入现有的乳腺癌筛查计划。
