Compliance with mammography screening in Israeli women: The impact of a pre-scheduled appointment and of the letter-style

The objectives of this study were to determine the impact of different personal invitations on screening mammography attendance and to clarify the influence of personal characteristics and health-related attitudes and behaviors on compliance. One thousand and five hundred women, aged 50-74 years, were randomly selected in the city of Haifa. Four letters of invitation were used. Actual mammography performance was validated by a national computerized database. All other data was collected via a telephone interview following the mammography. The overall compliance rate amounted to 45%. The major predictors of compliance were having had a clinical breast examination within the previous year (p = 0.0008), having a health professional recommend routine mammography (p = 0.01) and perceiving mammography as efficient in early detection of breast cancer (p = 0.02). Aggressiveness of message details, or a family physician's or higher authority's signature on the letter had no impact on compliance. A letter of invitation for a routine mammogram at a specific time resulted in an overall rate of compliance 3-fold higher than the baseline. Based on the results of this study, Kupat Holim Clalit decided to implement use of personal invitations for screening mammography to Israeli women on a regular basis.