The Mammography Screening Employee Inreach Program
Joanne Robinson, R.N., M.S.P.H., Vicki Seltzer, M.D., Loretta Lawrence, M.D., George Autz, M.D., Karen Kostroff, M.D., Lora Weiselberg, M.D., and Maria Colagiacomo
OBJECTIVE: To determine whether our health care employees were undergoing mammography screening according to American Cancer Society guidelines and to determine whether aggressive outreach, education and streamlining of mammography scheduling could improve compliance.
STUDY DESIGN: All female employees at North Shore University Hospital (NSUH) and several other health system facilities (SF) were sent mailings to their homes that included breast health education and mammography screening guidelines, a questionnaire regarding their own mammography screening history and the opportunity to have their mammography screening scheduled by the Mammography Screening Employee Inreach Program (MSEIP) coordinator.
RESULTS: Of the approximately 2,700 female employees aged 40 and over at NSUH and SF, 2,235 (82.7%) responded to the questionnaire, and 1,455 had a mammogram done via the MSEIP. Of the 1,455, 43% either were overdue for a mammogram or had never had one. During a second year of the MSEIP at NSUH and SF, an additional 1,706 mammograms were done.
CONCLUSION: People employed in health care jobs do not necessarily avail themselves of appropriate health care screening. An aggressive program that utilized education, outreach and assistance with scheduling was effective in increasing compliance with mammography screening. (J Reprod Med 2007;52:75–77)
Keywords: breast cancer, mammography, mass screening, employee inreach.
For women in the United States the second most common cause of death is cancer. Breast cancer is the most common cancer in U.S. women and the second leading cause of cancer death. The American Cancer Society (ACS) has published breast cancer screening guidelines, which include an annual mammogram beginning at age 40.1
The North Shore–Long Island Jewish Health System (NSLIJHS) is the fourth largest integrated not-for-profit health system in the United States. The NSLIJHS has >38,000 employees, of whom approximately 75% are women. The NSLIJHS has a very extensive community health education program, which is available to all employees. This education program has many lectures throughout the year, every year, focusing on breast health and the early detection of breast cancer. Despite this, we hypothesized that many employees might not be going for their mammography screening according to ACS guidelines. A second hypothesis was that with aggressive outreach, education and streamlining of mammography scheduling we would be able to have more of our employees compliant with these guidelines.
Materials and Methods
North Shore University Hospital (NSUH) is one of the tertiary hospitals of the NSLIJHS. This hospital and several other health system facilities (SF) that are within a 5-mile radius of NSUH, such as the Feinstein Institute for Medical Research, Core Laboratories and Center for Extended Care and Rehabilitation, have approximately 5,700 female employees.
A small, pilot survey of 100 female employees over the age of 40 who worked at NSUH was conducted in July 1999 to begin to assess our hypothesis that our own NSLIJHS employees were not necessarily compliant with the ACS mammography screening guidelines. The pilot survey revealed that 56 of the 100 women were noncompliant with the ACS recommendation to have annual mammograms. Having obtained this information, one of the authors obtained funding from the Joyce and Irving Goldman Family Foundation for the Mammography Screening Employee Inreach Program (MSEIP). These funds were used to hire a MSEIP inreach coordinator and purchase educational materials and mailings. The grant covered only the aforementioned services; the cost of the mammograms was billed to the employee’s insurer. This research was approved by the local institutional review board.
Between January and July 2001, all female employees of NSUH and SF were sent mailings to their homes. The mailings included educational materials regarding breast health and breast cancer screening. The mailings also included a questionnaire with a secure envelope in which it was to be returned. The questionnaire asked about the woman’s mammography screening history and also whether she would like to have a mammogram scheduled by the MSEIP inreach coordinator. The coordinator tracked the responses, scheduled the mammograms and saw that the women kept their scheduled appointments and sent second and third reminder mailings to nonresponders 4 and 8 weeks after the initial mailing.
Following the initial success at NSUH and SF, the MSEIP was subsequently initiated at several other NSLIJHS hospitals.
In 2001, NSUH and SF had approximately 7,540 employees, of whom approximately 5,700 (75.6%) were female. Of these employees, approximately 2,700 were 40 years of age or older. As a result of the information sent to all our female employees via the MSEIP, there were 2,235 responses by women aged 40 and over (an 82.7% response rate). Of these 2,235 responses, 1,466 women requested that MC schedule a mammogram for them via the MSEIP. Almost all the women aged 40 and over who responded to the survey but did not have their mammograms via the MSEIP indicated that they were already compliant with the ACS mammography screening guidelines.
Of the 1,466 women who requested that MC schedule a mammography for them, 2 cancelled their appointments, 9 did not come for their mammograms and did not reschedule, and 1,455 of the 2,700 women aged 40 and older (54%) had a mammogram done via this program. For 833 of the women (57%) this was their regular screening mammogram, and they had been in compliance with screening guidelines. However, 43% of the 1,455 women were either overdue for their mammograms or had never had any. In that group, 191 women had had their prior mammograms in 1999. One hundred fifty-nine women had their prior mammogram between 1990 and 1998. Two hundred seventy-two women had never had a mammogram. An additional 11 mammograms were performed via the MSEIP for women who were under the age of 40. Because of the educational materials that they received via the MSEIP, those 11 women understood that they were at high risk for breast cancer due to family history and therefore had screening mammographies scheduled via the MSEIP.
Among the original 1,466 mammography studies, 40 mammograms were read as Breast Imaging Reporting and Data Systems 4 or 5. Ultimately, 10 cancers were histologically confirmed in 9 women.
During the second year of the MSEIP at NSUH and SF, an additional 1,706 mammograms were completed.
Screening for breast cancer using mammography has been clearly demonstrated to identify earlier disease and to reduce breast cancer mortality.2-4 This has been shown to be true for women between the ages of 40 and 495-7 as well as for women 50 and older. It has been demonstrated that screening mammography reduces breast cancer mortality by 20–35% in women aged 50–69 and slightly less for women aged 40–49 after 14 years of follow-up.8
Despite this compelling evidence regarding the importance of mammography screening in reducing breast cancer mortality, many women do not avail themselves of this valuable study. Many women in the United States over the age of 40 have never had a mammogram, and many others do not have regular screening mammography at the intervals recommended by the ACS.
Our findings confirmed our first hypothesis that despite the fact that the employees of NSUH and SF work in a health system that has extensive community education programs available to them, a large percentage were not compliant with the ACS mammography guidelines. Our second hypothesis was also confirmed. By running an aggressive program with an employee dedicated to this project, posters in the hospital, word of mouth, mailings at home and assistance with scheduling, we were able to substantially increase compliance.
This program could have the potential to have many more far-reaching effects. It reinforces the value of screening and health promotion and may therefore change employees’ attitudes and habits regarding their own preventive health care and screening.
Optimal health care for employees can also result in enhanced health care for patients and communities. Employees who are encouraged to value the importance of breast cancer screening and early detection for themselves may be more inclined to demonstrate these values to patients, friends and neighbors.
One of the major reasons that this program was as successful as it was is that it had the enthusiastic support of the NSLIHS’s president and chief executive officer as well as the very strong support of the hospital’s executive director and other health system senior leadership. The program was repeatedly discussed and endorsed by these individuals at administrative meetings. In turn, the employees of the health system viewed this program very positively.
We think that this type of program can be conducted by any employer and that the employer does not need to be in a health care–related field. The program is not expensive to conduct. In addition, although we targeted mammography screening, other types of screening (e.g., cervical cancer screening, lipid screening) would also be amenable to this type of program.
In conclusion, the workplace affords an excellent opportunity to promote health awareness and healthful behaviors. It is an outstanding venue in which to reach working women (and men).
Our MSEIP provides an important template as a public health program, and we hope that other employers will consider implementing such a model.
From the Department of Obstetrics and Gynecology; Section of Breast Imaging, Department of Radiology; Division of Breast Surgery, Department of Surgery; Division of Medical Oncology, Department of Medicine; and Office of Community Health and Public Policy, North Shore–Long Island Jewish Health System, Great Neck, New York.
Supported by the Joyce and Irving Goldman Family Foundation.
Address correspondence to: Vicki Seltzer, M.D., North Shore–Long Island Jewish Health System, Department of Obstetrics and Gynecology, Long Island Jewish Medical Center, Suite 1100, 270-05 76th Avenue, New Hyde Park, NY 11040 (firstname.lastname@example.org).
Financial Disclosure: The authors have no connection to any companies or products mentioned in this article.
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