Date Created



Despite exhaustive efforts over the past several decades aimed at prevention, early detection, and improved treatment regimens, breast cancer remains the most commonly diagnosed cancer among American women and is nearly the deadliest; it is second only to lung cancer in mortality (American Cancer Society [ACS], 2019; Centers for Disease Control and Prevention, 2018a; National Cancer Institute [NCI}, 2018). Women of average risk carry a 12% or 1 in 8 chance of developing breast cancer in their lifetime. Most recent estimates reveal 270,000 new breast cancer cases and over 42,000 breast cancer related deaths will occur in 2019 (ACS, 2019). Screening mammography remains the gold standard for early detection of breast cancer; detection before signs and symptoms appear is shown to decrease mortality and improve survival related to breast cancer (NCI, 2016, 2018). Multiple barriers and disparities were discussed in the literature in relation to mammography adherence and screening rates remain suboptimal despite known benefits of this important preventive tool. This Doctor of Nursing Practice scholarly project further explored the background and influencing factors related to mammography adherence, integrated a comprehensive review of the literature, and provided an evidence-based quality improvement initiative tailored toward improving mammography adherence in the primary care setting. This quality improvement project was designed in collaboration with a local primary care clinic and breast diagnostic center. The project aimed to identify women in the community who were past due for a screening mammogram, identify past and current efforts to improve mammogram rates within the chosen clinical setting, and develop a multimodal outreach initiative to improve women’s adherence to timely mammogram screenings. A scripted, evidence-based telephone outreach initiative was developed and built upon in-person and reminder letter initiatives completed by the clinic prior to this project. Fifty women from the clinic who were of average lifetime risk, were at least 12 months past due for a screening mammogram, and had received both previous forms of outreach were included in the sample population. The post-intervention sample population consisted of 44 women; the project was successful in influencing 20% of participants to schedule a mammogram while 16% followed through in obtaining a mammogram. The results of this scholarly project are beneficial in providing the clinic and diagnostic center stakeholders with additional knowledge and methodology regarding breast cancer screening outreach in addition to reaffirming a theme revealed in the literature surrounding mammography adherence: improving mammogram rates for women who are past due for screening is best accomplished through multimodal outreach that progressively increases in intensity over time.


mammography adherence; mammogram; breast cancer screening; quality improvement project; Doctor of Nursing Practice (DNP); telephone outreach

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