Does a diagnosis of schizophrenia reduce rates of mammography screening? A Manitoba population-based study Harvey Max Chochinov a, ⁎, Patricia J. Martens b , Heather J. Prior b , Randall Fransoo b , Elaine Burland b and The Need To Know Team 1 a Department of Psychiatry, University of Manitoba, CancerCare Manitoba, Winnipeg, Manitoba, Canada b Department of Community Health Sciences, University of Manitoba, Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada article info Article history: Received 28 January 2009 Received in revised form 15 April 2009 Accepted 21 April 2009 Available online 8 May 2009 1. Introduction It is estimated that mammography screening can reduce mortality from breast cancer by 20–35% for women aged 50 to 69 years, and 20% for women aged 40 through 49 years (Elmore et al.; 2005; Fletcher and Elmore 2003). For women aged 50–69, the Canadian Task Force on the Periodic Health Examination (now known as the Canadian Task Force on Preventive Health Care) and the U.S. Preventive Services Task Force recommend mammo- graphy screening every 1–2 years (de Grasse et al., 1999; Ferrini et al., 1996; Ringash and Canadian Task Force on Preventive Health Care, 2001; US Preventive Services Task Force 2002). Manitoba's Breast Screening Program states that the best chances of reducing deaths from breast cancer arise from screening at least 70% of Manitoba women aged 50 through 69 every two years. According to the Statistics Canada Canadian Community Health Survey [CCHS] 3.1 (Statistics Canada 2005) 72.6% of women aged 50 through 69 years received a mammogram (screening or diagnostic) over a two-year period. Women in Manitoba self-reported much lower rates, at 65.6%, with 42.6% Schizophrenia Research 113 (2009) 95–100 ⁎ Corresponding author. Manitoba Palliative Care Research Unit, Department of Psychiatry, University of Manitoba, CancerCare Manitoba, Rm. 3017-675 McDermot Avenue, Winnipeg, Manitoba, Canada R3E 0V9. Tel.: +1 204 787 4933; fax: +1 204 787 4937. E-mail address: harvey.chochinov@cancercare.mb.ca (H.M. Chochinov). 1 A collaboration of the Regional Health Authorities of Manitoba, Manitoba Health & Healthy Living, and the Manitoba Centre for Health Policy, directed by P.J. Martens and co-directed by R. Fransoo. being for routine screening and 23.0% for other reason, presumably diagnostic or follow-up; this data does not include on-reserve First Nations women, a major limitation in the province of Manitoba. Though not entirely comparable, CDC (2007) reports mammography rates for the USA at 74.6% in 2005 for women aged 40 and above. Population-based screening programs in Canada were started based on the assumption that screening could reduce mortality by 30% in women aged 50–69, if 70% of women in this age range had a mammogram every two years (Gaudette et al., 1996). As of 1995, 22 countries had created national, sub- national or pilot population-based breast cancer screening pro- grams (Bourchard et al., 1999), including established programs in Australia, Canada, Finland, Iceland, Israel, Italy, Hungary, Japan, Netherlands, Sweden, UK, USA, and Uruguay; and many pilot programs in Europe, including Belgium, Denmark, France, Greece, Ireland, Luxembourg, Portugal, Spain. Canadian perfor- mance indicators on mammography screening compare favour- ably with those of other well-established international screening programs (Wadden and Doyle 2005). Most countries used a personal invitation system to recruit women for screen- ing; some also used media advertising and pamphlets, or referral by a primary care physician. Several countries used centres dedicated to mammography screening; others also had mobile units often used to reach rural, low income or other populations less likely to come to centralized centres (Bourchard et al., 1999). According to a Cochrane Collaboration review (Bonfill et al., 2001), evidence as to “what works” in increasing participation rates for mammography screening shows five successful strategies — letters of invitation (OR 1.66, 95% CI 1.43–1.92), mailed educational material (OR 2.81, 95% CI 1.96–4.02), letters of invitation plus phone calls (OR 2.53, 95% CI 2.02–3.18), telephone calls (OR 1.94, 95% CI 1.70–2.23), and training activities plus direct reminders for the women (OR 2.46, 95% CI 1.72–3.50). Home visits were not found to be effective. Personalized risk communication, whether written, spoken or 0920-9964/$ – see front matter © 2009 Elsevier B.V. All rights reserved. doi:10.1016/j.schres.2009.04.022 Contents lists available at ScienceDirect Schizophrenia Research journal homepage: www.elsevier.com/locate/schres