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

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 Prior research in Singapore is either outdated or limited in scope, and there is a particular lack of rigorous trials evaluating behavioral interventions tailored to women who have defaulted on screening,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

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, 4 weeks after the first

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

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

Sponsors & Collaborators

• National University Hospital, Singapore

  lead OTHER

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

2026-03-09

Primary Completion

2026-12-31

Completion

2027-12-31

Countries

• Singapore

Study Locations