Trial to Evaluate the Impact of Various Pragmatic Interventions to Increase Mammography Uptake Among Defaulted Repeat Screeners in Singapore

NCT07651345 | Enrolling By Invitation

• 1 other identifier: 2025-0790
• Study Type: interventional
• Target: 12,750
• Locations: 1 country
• Sites: 1

Brief Summary

Breast cancer is the most common cancer among women in Singapore, accounting for nearly 30% of all female cancers. While regular biennial mammography can reduce mortality, screening rates in Singapore remain low at 34.7%; well below the 70% threshold required for population-level impact. Despite a national screening program in place since 2002, uptake continues to be hindered by psychological, cultural, and logistical barriers. Although various studies have explored different behavioural interventions to boost mammogram uptake; ranging from reminders (traditional mailers, phone calls, text messages) and education to financial incentives, their effectiveness varies by population and context. Furthermore, few large-scale, prospective studies have been conducted locally. Prior research in Singapore is either outdated or limited in scope, and there is a particular lack of rigorous trials evaluating behavioral interventions tailored to women who have defaulted on screening, who faces distinct psychological and behavioral barriers; ranging from low perceived risk and fear, to false reassurance from prior normal results or lack of reminders, or had bad experience (procedural pain or prior false positive results) during last mammogram. Engaging these women is critical, yet challenging, and failure to do so undermines efforts to achieve broad population coverage. The REMIND Study addresses this critical gap by evaluating five pragmatic and scalable outreach strategies to increase mammogram uptake among women who had their last screening more than 2 years ago and are currently overdue. Through a large, randomized controlled trial, the study will generate much-needed local evidence on what works to reengage these women. Findings will directly inform national screening policies and the design of future outreach efforts tailored to Singapore's diverse population.

Conditions

Mammogram Uptake; Breast Cancer; Breast Neoplasm; Early Detection of Cancer; Early Breast Cancer Detection; Mammography Screening

Keywords

Mammography; Behavioural Intervention; Breast cancer detection; early detection; Mailed reminder; Cancer Screening; Breast cancer

Outcome Measures

Primary Outcomes (1)

• Comparison of proportion of participants completing surveillance mammography within 4 months after intervention assignment between interventional arms (2-5) and control arm (Arm 1)

  The proportion of women who undergo surveillance mammography within 4 months of receiving the study intervention/reminder will be compared between Arm 1 (control) and Arms 2-5. Mammogram completion will be confirmed through electronic medical records. Results will be reported as the percentage of participants completing mammography in each study arm. Unit of Measure: Percentage of participants (%)

  4 months from the time participants receive the intervention/reminder

Secondary Outcomes (3)

• Association between participant characteristics and completion of surveillance mammography within 4 months

  4 months from the time participants receive the intervention/reminder

• Post-trial telephone survey

  1-2 months post-trial

• Mammogram uptake at 6 and 12 months post-trial

  6 and 12 months from the time participants received the first mailed reminder

Study Arms (5)

Control Arm (Arm 1)

NO INTERVENTION

Does not receive any reminder to go for mammogram

Arm 2: One mailed reminder

EXPERIMENTAL

Receives a single mail reminder

Behavioral: Arm 2: One mailed reminder

Arm 3: Two mailed reminders

EXPERIMENTAL

Receives two mail reminders, 4 weeks apart

Behavioral: Arm 3: Two mailed reminders

Arm 4: Mailed Reminder with Prescheduled Appointment

EXPERIMENTAL

Receives a mailed reminder with prescheduled appointment

Behavioral: Arm 4: Mailed reminder with prescheduled appointment

Arm 5: Mailed reminder with enhanced messaging

EXPERIMENTAL

Receives mailed reminder with enhanced messaging

Behavioral: Arm 5: Mailed reminder

Interventions

Arm 3: Two mailed reminders BEHAVIORAL

Receives a mailed reminder + follow-up mailed reminder, 4 weeks after the first

Arm 3: Two mailed reminders

Arm 5: Mailed reminder BEHAVIORAL

Receives one mailed reminder with enhanced messaging motivating recipient to undergo screening

Arm 5: Mailed reminder with enhanced messaging

Arm 2: One mailed reminder BEHAVIORAL

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

Arm 2: One mailed reminder

Arm 4: Mailed reminder with prescheduled appointment BEHAVIORAL

Receives one mailed reminder with a pre-scheduled appointment, with instructions to change appointment

Arm 4: Mailed Reminder with Prescheduled Appointment

Eligibility Criteria

• Age: 50 Years - 69 Years
• Gender Eligibility Details: Females only
• 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 NUHS App
• Signed up with Healthier SG with a primary care provider within the NUHS Primary Care Network
• Must be defaulted repeat screeners : Must have done one prior mammogram screening but not in the past 2 years

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, Singapore

Location

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: SCREENING
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: May 21, 2026
• First Posted: June 16, 2026
• Study Start: March 9, 2026
• Primary Completion (Estimated): December 31, 2026
• Study Completion (Estimated): December 31, 2027
• Last Updated: June 16, 2026

Record last verified: 2026-04

Data Sharing

• IPD Sharing: Will not share

Locations

SG (1)