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Although a 1998 survey showed that 68 percent of women over age 40 had received a mammogram in the past 2 years, serious concerns remain about the many women who do not receive screening mammograms or are screened less frequently than recommended. Poor and minority women, who are less likely to visit doctors' offices where they could be reminded about mammograms, are the least likely to obtain them. Community-based screening programs may have a better chance of reaching such women, suggest Joanna E. Siegel, Sc.D., and Carolyn M. Clancy, M.D., of the Agency for Healthcare Research and Quality, in a recent commentary.
Drs. Siegel and Clancy discuss a recent study that examined the cost and cost-effectiveness of the Los Angeles Mammography Program (LAMP), which involved 45 churches and 2 interventions to improve rates of mammography screening: mail counseling (which did not work) and telephone counseling. The LAMP effort generated 3.24 additional screenings among 56 women, with most of this effect among women who previously had received at least one mammogram in the preceding 2 years. It is not clear whether this level of increase was adequate to make a difference in outcomes.
Future cost-effectiveness studies on this topic should be very clear about the chain of effectiveness linking program impact and behavioral or other changes and health outcomes, assert the authors. They also recommend that church-based and other community programs be compared with a range of alternative programs targeting women with limited access to mammography. These might include radio programming, health fairs, and outreach programs conducted by local community health workers. Drs. Siegel and Clancy point out that this is an area in which clinical solutions have fallen short, and they recommend that careful consideration be given to community-based and other approaches that may be outside the traditional purview of medicine.
More details are in "Community-based interventions: Taking on the cost and cost-effectiveness questions," by Drs. Siegel and Clancy, in the December 2000 Health Services Research 35(5), pp. 905-909.
Reprints (AHRQ Publication No. 01-R032) are available from the AHRQ Publications Clearinghouse.
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