Does participation in an epidemiological study improve appropriate prescription of screening mammography for asymptomatic women?

BACKGROUND: To analyze the effect of participating in an epidemiological study on quality of care (i.e., appropriate prescription of mammographic screening), we have analyzed data collected in the framework of a cross-sectional study conducted in Italy among women attending menopause clinics. METHODS: In 1997, a large cross-sectional study was organized on the characteristics of women who attended a network of first-level outpatient clinics for general counseling about menopause or treatment of menopausal symptoms. Women consecutively observed during the study were eligible, and the protocol did not set any exclusion criteria. All women who agreed to participate underwent a gynecological examination and were asked about their general characteristics and lifestyle habits, reproductive and menstrual history, and selected medical history. Laboratory and instrumental tests were required on clinical grounds; the protocol did not consider any test mandatory for all women, but all centers were asked to collect information on the examinations prescribed as routine clinical practice. The study began in 1997 in 25 centers. By March 1999, the number of centers had increased to 268 of which 63 were in the north, 81 in the center, and 124 in the south of Italy. Fewer than 3% of eligible women refused to participate. The study included 48,444 women. The present analysis looked at current attitudes toward screening mammography (SM) in asymptomatic women, as prescribed by gynecologists in menopausal centers in Italy. RESULTS: A SM was correctly requested in 55.6% of women who entered the study during the second semester of 1997. This rose to 72.8% by July-August 2000. The correct prescription of a SM was slightly higher in current users of hormonal replacement therapy (HRT) and lower in women aged 45-50 years, the differences being significant (P < 0.05). CONCLUSIONS: These results show that appropriate requests for SM increased in centers participating in a collaborative epidemiological study on menopause in Italy over a 3-year period.