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Mammography use in rural areas bolstered by volunteers

Volunteers who provide information and support can make a difference when it comes to increasing mammography use in rural areas, according to a large study of women from 40 communities throughout the state of Washington.

The community-intervention study was prompted by previous research that indicates rural residents are screened for cancer less frequently than urban residents, says the study's lead author, M. Robyn Andersen, Ph.D., of the Fred Hutchinson Cancer Research Center in Seattle.

"Despite evidence that regular breast-cancer screening significantly reduces breast-cancer mortality, many women in the United States do not receive regular screening," Andersen says.

Andersen and colleagues from the Hutchinson Center and the University of Washington tested three types of mammography-promotion approaches that employed volunteers. The study findings are published in the April issue of the American Journal of Preventive Medicine.

In the first approach, volunteers provided mammography information by telephone. Volunteer counselors reminded women about the value of regular mammograms and provided information about local facilities, including those with free and low-cost mammography options. They also addressed issues related to lack of physician referral and helped women address their fears of mammography results and other barriers to mammography use.

A second approach focused on building awareness and support of mammography screening within the community through activities such as mammography-theme bingo nights; beauty-shop promotions; community newsletters; and distribution of mammography information at local clubs, stores, libraries and golf courses. The third strategy combined aspects of the first two approaches.

From follow-up interviews three years after initiating the volunteer programs, the researchers found that their efforts had achieved positive, but very modest, improvements in mammography use among the 6,592 study participants, half of whom were regular users of mammography at the start of the study. The results are consistent with other large community trials that employed similar techniques, according to the researchers.

The three approaches achieved similar results, but the second approach, which focused on community activities, was the most effective. It was the only approach that resulted in statistically significant increases in mammography usage.

The community-activity approach increased mammography use among women who were already regular users by 2.9 percent. This intervention also increased mammography use among certain groups of women who were not regular users at the beginning of the study, including those in communities without female physicians and those without health insurance.

"It is possible that female physicians working in rural communities serve as local specialists in areas related to women's health care or act as local spokespeople promoting mammography use," says Andersen, an assistant member of the Hutchinson Center's Public Health Sciences Division.

"If so, community interventions may be most effective in communities where there aren't local physicians actively promoting cancer screening. In such communities trained volunteers may serve as credible, trustworthy sources of information," she concludes.

The researchers speculate that the community-activity approach was most effective because the volunteers spent a longer period of time with the women, as compared to the volunteers who provided phone counseling or those asked to do both telephone counseling and community activities.

They also suggested another possibility - that the first, and especially the third, approaches may have been too much of a strain on the volunteers, not necessarily in terms of time spent but in terms of the intensity of interpersonal interactions required. "It is possible to ask too much of volunteers," Andersen says.

This research was supported by a grant from the National Cancer Institute.
Editor's note: To arrange an interview with Dr. Andersen, please contact Kristen Woodward, (206) 667-5095. For more information about the American Journal of Preventive Medicine, contact the editorial office at (619) 594-7344.

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The Fred Hutchinson Cancer Research Center is an independent, nonprofit research institution dedicated to the development and advancement of biomedical technology to eliminate cancer and other potentially fatal diseases. Recognized internationally for its pioneering work in bone-marrow transplantation, the Center's four scientific divisions collaborate to form a unique environment for conducting basic and applied science. The Hutchinson Center is the only National Cancer Institute-designated comprehensive cancer center in the Pacific Northwest. For more information, visit the Center's Web site at <>

CONTACT: Kristen Woodward
(206) 667-5095

March 16, 2000