Does Mobile Mammography Increase Screening in Older Women?

Institution: University of California, Los Angeles
Investigator(s): David Reuben, M.D. - Roshan Bastani, Ph.D. - Roshan Bastani, Ph.D. -
Award Cycle: 1998 (Cycle IV) Grant #: 4EB-6100 Award: $520,640
Award Type: TRC Full Research Award
Research Priorities
Detection, Prognosis and Treatment>Imaging, Biomarkers, and Molecular Pathology: improving detection and diagnosis

This is a collaboration with: 4EB-6101 -

Initial Award Abstract (1998)
Despite the consensus that older women should receive screening mammography, screening rates remain suboptimal. Although mobile mammography has the potential of increasing mammography rates in older women, its effectiveness in this population is essentially untested. We have designed a randomized clinical trial to determine the additional benefit of offering on-site screening mammography in addition to a health education intervention to low-income, ethnically diverse, urban-dwelling older women.

This study will recruit low-income, ethnically diverse, urban-dwelling, elderly women to participate in the study by holding Senior Women's Health Days at senior meal sites and other sites where older persons congregate. At all sites, participants will receive a health education intervention designed to increase mammography. At a randomly selected 50% sample of sites, participants will be offered on-site mammography using a mobile unit. We will then conduct follow-up interviews to determine the use of mammography services in both groups. The research will address both the effectiveness and the cost-effectiveness of patient education alone compared to patient education plus on-site mammography provided by a mobile van. The research involves a unique partnership between a university (UCLA), a private research entity (Rand Corporation), and two community organizations (the City and County of Los Angeles Area Agencies on Aging) and brings together expertise in clinical, social-behavioral, and health care economics research.

The interventions that are developed and tested in this study can be readily incorporated into at-risk Medicare health plans or other large health care organizations to facilitate earlier detection of breast cancer. The study's outcomes should also influence public policy regarding support of mobile mammography and health education efforts and will provide important information for communities and health care organizations as they plan to optimize breast cancer screening for older women.


Final Report (2002)
Despite consensus that older women should receive screening mammography, screening rates remain suboptimal. Mobile mammography has the potential of increasing mammography rates in older women; however, its effectiveness in this population is essentially untested.

We conducted a randomized clinical trial to determine the additional benefit of offering on-site screening mammography beyond a health education intervention for low-income, ethnically diverse, urban-dwelling older women.

Screening for the study was conducted at 60 community sites where older persons gather. A total of 683 women aged 60-84 years met the eligibility criteria for the study and 74% (n=499) of these participated in the study. Of these 252 were randomly assigned to the combined health education and mobile mammography group and 247 were assigned to the health education only group. Three months following the intervention, we determined whether a mammogram had been performed since study enrollment on 93% (n=463) of participants.

Our results indicate that the availability of the on-site mammography resulted in higher rates of mammography among these older women (55% versus 40%, p=0.001) compared to those who received only health education. Of particular interest, on-site mammography availability appeared to be especially effective compared to education only in Latina American women (56% versus 30%, p=0.020) and Asian-Pacific Islander women (70% versus 35%, p=0.015), the latter two achieving statistical significance results. Of the 129 mammograms reported by women who had access to on-site mammography, 120 (93%) were administered on-site.

To date, these results have been presented at several conferences and our manuscript, "What is the Additional Benefit of Mobile Mammography beyond Health-education Outreach for Older Community-based Women? A Randomized Clinical Trial" has been accepted for publication by the American Journal of Roentgenology.

Current analyses are focused on the cost-effectiveness of mobile mammography in this population (e.g., the number that would need to be screened at each site to make it cost-effective) and a draft of the manuscript is in preparation. A second manuscript in preparation examining baseline surveys to determine characteristics that distinguish women who were due for mammography (last mammogram 1-2 years ago) versus those who were long overdue or had never received a mammogram. An additional planned manuscript will examine predictors of receipt of mammography during the program including changes in knowledge and attitudes as a result of the intervention.

These findings will provide further support for mobile mammography as a means of increasing adherence with this important preventive service and may be a particularly effective strategy for populations who have historically low screening rates.

A randomized clinical trial to assess the benefit of offering on-site mobile mammography in addition to health education for older women
Periodical:American Journal of Roentgenology
Index Medicus: Am J Roentgenol
Authors: Reuben DB, Bassett LW, Hirsch SH, Jackson CA, Bastani R
Yr: 2002 Vol: 179 Nbr: 6 Abs: Pg:1509-14