title: A randomized trial of the impact of risk assessment and feedback on participation in mammography screening.
abstract: BACKGROUND
  Although rates of mammography screening among women in the general population have been increasing they still fall short of national goals. This study evaluated the effects on rates of participation in mammography screening of obtaining risk factor information and providing general or personalized risk information through direct mailed correspondence.
  
  
  METHODS
  Women enrollees in a health maintenance organization (N = 2,076), age 50 and above, were randomized to one of the following four groups: (a) no risk factor questionnaire + generic invitation, (b) no risk factor questionnaire + general risk invitation, (c) risk factor questionnaire + general risk invitation, and (d) risk factor questionnaire + personal risk invitation. Computerized visit records were monitored for 12 months following a mailed invitation to assess whether a mammogram had been obtained.
  
  
  RESULTS
  Overall participation was 37.5% and the rate of participation did not differ significantly across groups (P = 0.26). Participation was related to age (P < 0.02), with rates highest for women ages 60-69 years (42.7%) compared with those for women ages 50-59 (35.5%) and those age 70+ (33.7%). Among women with a family history of breast cancer, the personalized risk invitation was associated with significantly higher participation compared with general risk invitation (66.7 versus 42.9%, respectively; P < 0.003).
  
  
  CONCLUSIONS
  Women with a family history of breast cancer are more likely to obtain a mammogram if that fact is reinforced as a risk factor. Research on environmental barriers to mammography screening may suggest alternative strategies for increasing participation.
authors.affiliation: Center for Health Studies, Group Health Cooperative of Puget Sound, Seattle, Washington 98101.
authors.forename: S J
authors.initials: SJ
authors.lastname: Curry
authors.forename: S H
authors.initials: SH
authors.lastname: Taplin
authors.forename: C
authors.initials: C
authors.lastname: Anderman
authors.forename: W E
authors.initials: WE
authors.lastname: Barlow
authors.forename: C
authors.initials: C
authors.lastname: McBride
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000517:prevention & control; D005260:Female; D006279:Health Maintenance Organizations; D006305:Health Status Indicators; D006801:Humans; D016015:Logistic Models; D008327:Mammography / Q000523:psychology / Q000706:statistics & numerical data*; D008403:Mass Screening / Q000523:psychology / Q000706:statistics & numerical data*; D008487:Medical History Taking; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010342:Patient Acceptance of Health Care; D016016:Proportional Hazards Models; D011795:Surveys and Questionnaires