Trial to Evaluate the Impact of Various Behavioural Interventions to Increase Mammography Uptake Among Singaporean Women

Condition(s) studied

Investigational drug(s) / intervention(s)

Arm 2: One mailed reminder: Receives a mailed reminder with basic information about breast cancer and instructions on scheduling a mammogram

Arm 3: Two mailed reminders: Receives a mailed reminder + follow-up mailed reminder, 1 month after the first reminder

Arm 4: Mailed reminder with prescheduled appointment: Receives one mailed reminder with a pre-scheduled appointment, with instructions to change appointment

Arm 5: Mailed reminder with enhanced messaging: Receives one mailed reminder with enhanced messaging motivating recipient to undergo screening

Study summary

Breast cancer is the leading cancer among women in Singapore, yet mammography screening rates remain critically low at 34.7%, despite the availability of a national program since 2002. This shortfall significantly limits the potential of screening to reduce mortality at a population level. While various behavioral interventions have been tested internationally to increase uptake, their applicability in the local context remains uncertain. Existing studies in Singapore are either outdated, small in scale, or not sufficiently targeted. In particular, two subgroups of women warrant closer examination due to the scarcity of data: (1) never-screeners: those who have never undergone a mammogram and (3) recent screeners: those who had a mammogram more than two years ago but have not scheduled their next one. These cohorts exhibit distinct behavioral and psychological barriers that prevent adherence to regular, guideline-recommended screening. E.g., key barriers for never- screeners include low perceived susceptibility to breast cancer, lack of awareness about the benefits of early detection, fear or anxiety about pain or receiving a cancer diagnosis, cultural or personal modesty concerns or lack of a physician's recommendation. In contrast, the repeat recent screeners often have a misconception that a single normal result is sufficient, negative experiences during prior screenings (e.g., false positives, pain), absence of reminder systems and competing life priorities and lack of time. Among these, engaging never-screeners is particularly challenging, as they may not perceive screening as personally relevant or necessary, and many have successfully avoided the healthcare system for years. Yet, failure to engage these groups; poses a significant public health concern, as it undermines the effectiveness of population-level cancer control strategies. The PROMPT study is designed to fill this critical gap by systematically evaluating multiple low-cost, scalable outreach strategies in two parallel randomized trials. Its findings will provide robust, local evidence to inform policy and improve engagement of these hard-to-reach populations.

Eligibility

Primary outcome measure(s)

• Comparison of Mammogram Uptake Between Interventional Arms (2-5) and Control Arm (Arm 1) — 4 months from the time participants receive the reminders
  Comparison of the proportion of women who undergo surveillance mammography among participants in Arms 2-5 versus Arm 1 (control arm).

Trial sites (1)

More National University Hospital, Singapore trials in Singapore