Reminder recall is associated with higher mammogram uptake among overdue repeat screeners: an exploratory telephone survey within a randomized trial.
8 affiliations
- 1Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore.
- 2Department of Hematology-Oncology, National University Cancer Institute, Singapore, Singapore.
- 3Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
- 4Insight and System, Regional Health System Office, National University Health System, Singapore, Singapore.
- 5Department of Pharmacology and Medicine, National University of Singapore, Singapore, Singapore.
- 6Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore. [email protected].
- 7Department of Hematology-Oncology, National University Cancer Institute, Singapore, Singapore. [email protected].
- 8Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. [email protected].
Abstract
Background
Despite more than two decades of a national breast cancer screening program, fewer than 40% of eligible women in Singapore undergo recommended biennial mammography. This study evaluated the effectiveness of screening reminders in promoting mammogram completion in a setting without routine reminders and examined the motivators, barriers, and perceptions influencing mammogram uptake, among women overdue for repeat screening.Methods
An exploratory, cross-sectional telephone survey was conducted from January to February 2025 as a sub-study nested within a randomized controlled trial (RCT) in a tertiary healthcare system in Singapore. The five-arm parent RCT enrolled 9,000 women aged 50-69 who were overdue for repeat mammography and randomized them in a 2:1:1:1:1 ratio, with all participants receiving a mailed reminder (MR) and three mobile-app push notifications (PN), while arms 2-5 received additional behavioural interventions including a voucher, lottery incentive, motivational video, or scheduling assistance. In the telephone survey conducted three-weeks post parent RCT completion, approximately 60 women per trial arm were contacted. The survey assessed recall of reminders and its association with mammogram scheduling and completion, as well as participants' perceived motivators and barriers to screening.Results
Of 2,941 unique calls made, 749 women (25%) were reached, of whom 303 (40%) completed the survey (median age 63 years). MR recall (50.2%) exceeded PN recall (34.0%; p < 0.001), with no demographic or arm-specific differences. MR recall was associated with higher rates of mammogram completion (n = 40/152, 26.3%) compared with no MR recall (n = 10/151, 6.6%; odds ratio 5.04; 95% CI: 2.41-10.51, p < 0.001). Key motivators for screening were awareness (51%), receipt of MR (24%), and social/physician recommendations (18.6%); barriers were scheduling conflicts (26%), prior appointments (24%), and low awareness (17%).Conclusions
MR recall was associated with higher mammogram uptake among overdue repeat screeners. Timely reminders, simplified scheduling, and close follow-up remain key to overcoming behavioural barriers to screening in high-access health systems.Trial registration
The trial was registered at ClinicalTrials.gov (NCT06733155).
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BibTeX
@article{lucky2026reminder,
title = {{Reminder recall is associated with higher mammogram uptake among overdue repeat screeners: an exploratory telephone survey within a randomized trial.}},
author = {Sasidharan Swarnalatha Lucky and Wenyun Li and Samuel G W Ow and Lukas Loh and Jun Hui Tan and Boon-Cher Goh and Soo-Chin Lee},
journal = {BMC medicine},
year = {2026},
month = jul,
doi = {10.1186/s12916-026-05112-3},
url = {https://europepmc.org/article/MED/42972567},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Reminder recall is associated with higher mammogram uptake among overdue repeat screeners: an exploratory telephone survey within a randomized trial.
AU - Sasidharan Swarnalatha Lucky
AU - Wenyun Li
AU - Samuel G W Ow
AU - Lukas Loh
AU - Jun Hui Tan
AU - Boon-Cher Goh
AU - Soo-Chin Lee
PY - 2026
DA - 2026/07/31
JO - BMC medicine
DO - 10.1186/s12916-026-05112-3
UR - https://europepmc.org/article/MED/42972567
AB - Background Despite more than two decades of a national breast cancer screening program, fewer than 40% of eligible women in Singapore undergo recommended biennial mammography. This study evaluated the effectiveness of screening reminders in promoting mammogram completion in a setting without routine reminders and examined the motivators, barriers, and perceptions influencing mammogram uptake, among women overdue for repeat screening.Methods An exploratory, cross-sectional telephone survey was conducted from January to February 2025 as a sub-study nested within a randomized controlled trial (RCT) in a tertiary healthcare system in Singapore. The five-arm parent RCT enrolled 9,000 women aged 50-69 who were overdue for repeat mammography and randomized them in a 2:1:1:1:1 ratio, with all participants receiving a mailed reminder (MR) and three mobile-app push notifications (PN), while arms 2-5 received additional behavioural interventions including a voucher, lottery incentive, motivational video, or scheduling assistance. In the telephone survey conducted three-weeks post parent RCT completion, approximately 60 women per trial arm were contacted. The survey assessed recall of reminders and its association with mammogram scheduling and completion, as well as participants' perceived motivators and barriers to screening.Results Of 2,941 unique calls made, 749 women (25%) were reached, of whom 303 (40%) completed the survey (median age 63 years). MR recall (50.2%) exceeded PN recall (34.0%; p < 0.001), with no demographic or arm-specific differences. MR recall was associated with higher rates of mammogram completion (n = 40/152, 26.3%) compared with no MR recall (n = 10/151, 6.6%; odds ratio 5.04; 95% CI: 2.41-10.51, p < 0.001). Key motivators for screening were awareness (51%), receipt of MR (24%), and social/physician recommendations (18.6%); barriers were scheduling conflicts (26%), prior appointments (24%), and low awareness (17%).Conclusions MR recall was associated with higher mammogram uptake among overdue repeat screeners. Timely reminders, simplified scheduling, and close follow-up remain key to overcoming behavioural barriers to screening in high-access health systems.Trial registration The trial was registered at ClinicalTrials.gov (NCT06733155).
SN - 1741-7015
ER -