A Resident-driven Initiative Toward Improvement in Breast Cancer Screening Adherence

From the 2022 HVPA National Conference

Matthew Reeder MD (Cleveland Clinic Foundation), Basel Bazerbachi MD, Adam Fawaz MD, John Gaskill DO, Helene Puzio DO, Nivaas Thanoo MD, Arsal Tharwani MD, Katie Shen MD, Jessica Donato MD


Breast cancer is the most common cancer type and second leading cause of cancer death in women. Routine biennial conventional mammography screening, per the United States Preventive Services Task Force (USPSTF) recommendations, has been associated with an approximate 20-30% relative reduction in breast cancer mortality. Therefore, reducing barriers to care access is of critical importance. However, within the Cleveland Clinic health system there remains no standardized patient outreach system to promote mammography scheduling once an order for screening has been placed by a provider.


The objective of this project was to assess barriers to screening mammography scheduling and assess the efficacy of a provider-led outreach system.


The outpatient care panels of eight Internal Medicine residents at the Cleveland Clinic Main Campus were reviewed for this project. Each patient panel was reviewed for patients eligible for routine mammography screening who had active standing mammography orders in place. Within this subset, patients without an active mammography exam date were identified. These patients were subsequently referred to each resident’s site-specific scheduling team to assist with targeted outreach. Demographic, scheduling status, and exam completion rate were collected following intervention.


A total of 40 patients were selected for outreach. At the time of follow up, a total of 8 (20%) of patients had scheduled a mammogram with 2 (5%) having completed the mammography screening exam. Additional data including demographics, clinic-specific scheduling rates, and the efficacy of a direct provider-to-patient outreach system is pending at the time of submission.


Routine screening is of vital importance to the early detection and treatment of breast cancer in appropriate populations. Ensuring initiation and adherence to routine screening remains a complex issue, with multiple patient and care-system centric factors at play. Exam scheduling and completion remains a barrier near the end of this care path. Our hope is that targeted outreach will improve rates of mammography completion in this population, without significant additional resource investment.

Clinical Implications

An outreach system with minimal resource commitment may lead to significant improvement in routine breast cancer screening adherence rates.

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