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

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 Existing studies in Singapore are either outdated, small in scale, or not sufficiently targeted.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.

Sex

Female

Minimum age

50 Years

Maximum age

69 Years

Inclusion Criteria:

* 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
* For "never-screener" cohort: Must have never undergone mammogram screening
* For "repeat-screener" cohort : Must have completed screening in the last 18-24 months but have not booked their next appointment yet

Exclusion Criteria:

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