Trial to Evaluate the Impact of Various Interventions to Increase the Uptake of Surveillance Mammography in Eligible Women in Singapore

NCT06733155 | Enrolling By Invitation

• 1 other identifier: 2023/01007
• Study Type: interventional
• Target: 12,000
• Locations: 1 country
• Sites: 1

Brief Summary

Breast cancer is the most common cancer among women in Singapore, with more than 70 women out of every 100,000 being diagnosed each year. Early detection through regular mammograms can significantly reduce deaths from breast cancer. Although Singapore has had a national breast cancer screening program (now part of the Screen for Life initiative) for over 20 years, and the government offers substantial subsidies to make screening more affordable, participation remains low at only 30-40%. This low uptake is due to factors like fear, lack of awareness, cultural beliefs, and a perceived low risk of breast cancer. To be effective on a large scale, at least 70% of women need to participate in regular mammography screenings. While researchers in Singapore and Asia have studied the reasons behind low screening rates, there is still a lack of large-scale studies that test different strategies to increase mammography participation in these regions. This trial will recruit 12,000 women aged 50-69 who have not undergone a mammogram in the past two years. 9000 women will be randomized into five intervention arms. The interventions include: direct mail reminder (Arm 1, control, n=3000), financial incentive (Arm 2, n=1500), lottery incentive (Arm 3, n=1500), health messaging from an influential figure (Arm 4, n=1500), and personal health concierge for appointment scheduling (Arm 5, n=1500). Another 3000 women will be placed in a non-interventional arm (NI arm) for observational analysis, that receives no reminders at all. A post-intervention telephone survey will assess intervention effectiveness. The primary outcome is mammogram uptake across intervention arms with Arm 1 as a reference. Secondary outcome will be to compare Arm 1 with NI arm. Subgroup analyses will evaluate differences in uptake by sociodemographic factors, such as ethnicity and socioeconomic status. A cost-effectiveness analysis will assess the financial viability of each intervention. This is the first large-scale study in Singapore and Asia to compare multiple interventions to boost mammography uptake. Findings will provide evidence-based strategies to improve breast cancer screening participation, potentially reducing breast cancer mortality and informing future public health policy.

Conditions

This Study Evaluates Interventions to Increase Surveillance Mammography Uptake for Early Breast Cancer Detection Among Singaporean Women

Keywords

Breast Neoplasms; Mammography

Outcome Measures

Primary Outcomes (1)

• Comparison of Mammogram Uptake Between Intervention Arms (2-5) and Control Arm

  Primary endpoint: Comparison of the proportion of women who undergo surveillance mammography among participants in Arms 2-5 versus Arm 1 (control arm).

  3 month from study start or 4 months from randomization

Study Arms (6)

Observational Arm

NO INTERVENTION

Does not receive any mailer reminder to go for mammogram.

Arm 1 (control)

EXPERIMENTAL

Receives a mail reminder with basic information about breast cancer and instructions on scheduling a mammogram

Other: Only reminder mailer

Arm 2: Financial incentive

EXPERIMENTAL

Receives mail reminder + a $10 voucher for completing a mammogram within three months.

Other: Financial intervention

Arm 3: Lottery incentive

EXPERIMENTAL

Receives mail reminder + chance to win a $5000 lottery for completing the screening within three months.

Other: Lottery intervention

Arm 4: Health messaging

EXPERIMENTAL

Receives mail reminder + QR code to a 60-second video from an influential person, available in four languages (English, Chinese, Malay, Tamil).

Other: Health Messages

Arm 5: Personal Health Concierge

EXPERIMENTAL

Receives mail reminder + a dedicated hotline for scheduling mammograms with the help of a health concierge over eight weeks.

Other: Personal Health Concierge

Interventions

Financial intervention OTHER

Participants completing the mammogram within the study end date will receive a $10 voucher.

Arm 2: Financial incentive

Lottery intervention OTHER

Participants completing the mammogram within the study end date will receive achance to win a $5000 lottery.

Arm 3: Lottery incentive

Health Messages OTHER

Participants will receive a less than 5 minute long video from an influential person. The video will be available in four languages (English, Chinese, Malay, Tamil).

Arm 4: Health messaging

Personal Health Concierge OTHER

Participants will be able to call a dedicated hotline for scheduling mammograms with the help of a health concierge over eight weeks of receive the the mailer.

Arm 5: Personal Health Concierge

Only reminder mailer OTHER

Receives a mail reminder with basic information about breast cancer and instructions on scheduling a mammogram.

Arm 1 (control)

Eligibility Criteria

• Age: 50 Years - 69 Years
• Sex: female
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Singaporean citizen
• Age 50-69
• Registered as a patient at the National University Hospital
• Registered and active user of OneNUHS App
• Signed up with Healthier SG with a primary care provider within the NUHS Primary Care Network

You may not qualify if:

• Diagnosis of breast cancer in EPIC
• Mammogram done in the past 24 months in EPIC

Sponsors & Collaborators

• National University Hospital, Singapore: lead

Study Sites (1)

National University Hospital

Singapore, Singapore

Location

Related Publications (1)

• Lee SC, Lucky SS, Zhu J, Ow S, Loh L, Tan JH, Lim SE, Hairom Z, Mehta S, Tai BC, Goh BC. Pragmatic Interventions to Boost Surveillance Mammogram Uptake Among an Overdue Population: A Randomized Clinical Trial. JAMA Intern Med. 2026 Jan 1;186(1):27-35. doi: 10.1001/jamainternmed.2025.5873.

  PMID: 41212556 DERIVED

MeSH Terms

Conditions

Breast Neoplasms

Condition Hierarchy (Ancestors)

Neoplasms by Site; Neoplasms; Breast Diseases; Skin Diseases; Skin and Connective Tissue Diseases

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: PREVENTION
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Model Details: This study follows a parallel assignment model where participants are randomly assigned to one of five distinct arms: a control arm or one of four intervention arms. Each arm receives a different intervention, and the effects are compared to assess the impact on the uptake of surveillance mammography.

Study Record Dates

• First Submitted: December 10, 2024
• First Posted: December 13, 2024
• Study Start: September 16, 2024
• Primary Completion: December 31, 2024
• Study Completion: December 31, 2025
• Last Updated: May 22, 2025

Record last verified: 2024-10

Data Sharing

• IPD Sharing: Will not share

Locations

SG (1)