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Personalized form letters may improve breast and cervical cancer screening among low-income and minority women

Low-income and minority women are less likely to have cancer detected at an early stage and are more likely to die from cancer than other women. Sending a personalized form letter with general cancer information to these women increases their likelihood of being screened for cervical and breast cancer, according to a new study supported by the Agency for Healthcare Research and Quality (HS08581).

Maria L. Jibaja-Weiss, Ed.D., of the Baylor College of Medicine, and her colleagues randomly assigned 1,574 urban low-income and minority women (black, Hispanic, and white) receiving care at county health clinics to receive one of two types of letters. The first group received a personalized form letter containing general cancer information about the risk factors for breast and cervical cancer. It encouraged women to get a Pap smear and mammogram to screen for these diseases.

The second group received a personalized tailored letter, which cited a woman's individual risks for these cancers based on her medical records, such as her smoking habit or family history of cancer. Both letters were written at a sixth-grade reading level in both English and Spanish. The researchers examined the impact of letter receipt on breast and cervical cancer screening 1 year after receipt of the letter.

Nearly half (44 percent) of women who received the form letter received cervical screening services compared with 24 percent in the tailored letter group and 40 percent of the control group (who received no letter). Similarly, only 13 percent of the tailored letter group received screening mammography compared with 31 percent of the form letter group and 21 percent in the control group. Personalized tailored letters may decrease the likelihood of cancer screening among medically underserved low-income and minority women, conclude the researchers. They suggest that perhaps the women saw these letters as too alarming, which made them anxious about getting screened for fear of what might be discovered. On the other hand, the risk information communicated in the letter may have been too limited.

More details are in "Tailored messages for breast and cervical cancer screening of low-income and minority women using medical records data," by Dr. Jibaja-Weiss, Robert J. Volk, Paul Kingery, and others, in Patient Education and Counseling 50, pp. 123-132, 2003.

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