Improving Engagement With Breast Cancer Screening Through Structured Telephone Outreach Among Uninsured Women

Background Financial barriers, limited healthcare engagement, and gaps in preventive care contribute to delayed breast cancer screening among uninsured women. This study evaluated mammography completion within 60 days and secondary measures of breast cancer screening engagement following structured telephone outreach combined with facilitated scheduling through a free state-sponsored screening program among uninsured women overdue for mammography. Hypothesis We hypothesized that structured telephone outreach offering facilitated access to free mammography would support patient engagement across the screening cascade, including successful contact, referral acceptance, and facilitated scheduling, with mammography completion assessed as the primary clinical outcome. Methods This single-arm quality improvement study was conducted at a federally qualified health center in Birmingham, Alabama, United States. Eligible participants were uninsured women aged 52-74 with no documented mammogram within the preceding 24 months. Electronic medical record (EMR) review was used to verify screening status and identify potential barriers to screening. Trained medical students conducted standardized telephone outreach that included notification of overdue screening status, brief education regarding early detection, and an offer to schedule a free mammogram through the Alabama Breast and Cervical Cancer Early Detection Program (ABCCEDP). Up to three call attempts were made within 48 hours. The primary outcome was documented mammography completion within 60 days of initial telephone outreach. Secondary outcomes included mammography completion within 30 days, successful patient contact, referral acceptance, completion of an ABCCEDP visit, mammography scheduling, and documented barriers to screening. Results Among 361 eligible patients, 110 (30.5%) were successfully contacted, of whom 70 (63.6%) accepted referral and were transferred to scheduling. Among the 70 referred patients, two (2.9%) had documented mammography completion within 30 days and three (4.3%) within 60 days. At 60 days, three patients (4.3%) had completed an ABCCEDP visit only, 12 (17.1%) had completed an ABCCEDP visit and scheduled a mammogram, and 52 (74.3%) had no documented follow-through. Common patient-reported barriers included fear of abnormal results, competing health priorities, transportation or time limitations, preference for discussing screening with a primary care provider, and personal preference. Conclusions Structured telephone outreach paired with facilitated scheduling appears to be a feasible, low-cost strategy to support engagement with breast cancer screening, including patient contact, referral acceptance, and facilitated scheduling, among uninsured women. However, persistent barriers beyond the initial referral process highlight the need for enhanced patient navigation and continued follow-up to improve screening completion.