Trial to Evaluate the Impact of Various Behavioural Interventions to Increase Mammography Uptake Among Singaporean Women

Summary

Breast cancer is the leading cancer among women in Singapore, yet mammography screening rates remain critically low at 34.7%, despite the availability of a national program since 2002. This shortfall significantly limits the potential of screening to reduce mortality at a population level. While various behavioral interventions have been tested internationally to increase uptake, their applicability in the local context remains uncertain. Existing studies in Singapore are either outdated, small in scale, or not sufficiently targeted. In particular, two subgroups of women warrant closer examination due to the scarcity of data: (1) never-screeners: those who have never undergone a mammogram and (3) recent screeners: those who had a mammogram more than two years ago but have not scheduled their next one. These cohorts exhibit distinct behavioral and psychological barriers that prevent adherence to regular, guideline-recommended screening. E.g., key barriers for never- screeners include low perceived susceptibility to breast cancer, lack of awareness about the benefits of early detection, fear or anxiety about pain or receiving a cancer diagnosis, cultural or personal modesty concerns or lack of a physician's recommendation. In contrast, the repeat recent screeners often have a misconception that a single normal result is sufficient, negative experiences during prior screenings (e.g., false positives, pain), absence of reminder systems and competing life priorities and lack of time. Among these, engaging never-screeners is particularly challenging, as they may not perceive screening as personally relevant or necessary, and many have successfully avoided the healthcare system for years. Yet, failure to engage these groups; poses a significant public health concern, as it undermines the effectiveness of population-level cancer control strategies. The PROMPT study is designed to fill this critical gap by systematically evaluating multiple low-cost, scalable outreach strategies in two parallel randomized trials. Its findings will provide robust, local evidence to inform policy and improve engagement of these hard-to-reach populations.

Conditions

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

Interventions

BEHAVIORAL

Arm 2: One mailed reminder

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

BEHAVIORAL

Arm 3: Two mailed reminders

Receives a mailed reminder + follow-up mailed reminder, 1 month after the first reminder

BEHAVIORAL

Arm 4: Mailed reminder with prescheduled appointment

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

BEHAVIORAL

Arm 5: Mailed reminder with enhanced messaging

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

Sponsors & Collaborators

• National University Hospital, Singapore

  lead OTHER

Principal Investigators

• Soo-Chin Lee, MBBS, MRCP · National University Hospital Singapore, Singapore

Study Design

Allocation

RANDOMIZED

Purpose

SCREENING

Masking

NONE

Model

PARALLEL

Eligibility

Min Age

50 Years

Max Age

69 Years

Sex

FEMALE

Healthy Volunteers

Yes

Timeline & Regulatory

Start

2025-11-17

Primary Completion

2026-12-31

Completion

2027-12-31

Countries

• Singapore

Study Locations