This Study Evaluates Interventions to Increase Surveillance Mammography Uptake for Early Breast Cancer Detection Among Singaporean WomenNCT06733155
Trial to Evaluate the Impact of Various Interventions to Increase the Uptake of Surveillance Mammography in Eligible Women in Singapore
A study testing Financial intervention, Lottery intervention and Health Messages in people with This Study Evaluates Interventions to Increase Surveillance Mammography Uptake for Early Breast Cancer Detection Among Singaporean Women, run by National University Hospital, Singapore at 1 site in Singapore.
Trial summary
Breast cancer is the most common cancer among women in Singapore, with more than 70 women out of every 100,000 being diagnosed each year. Early detection through regular mammograms can significantly reduce deaths from breast cancer. Read more about this study
- Who is it for?
- Ages 50 to 69 years, women onlyHealthy volunteers can take part
- Conditions the study is for
- This Study Evaluates Interventions to Increase Surveillance Mammography Uptake for Early Breast Cancer Detection Among Singaporean Women
- What is being tested?
- Financial intervention, Lottery intervention and Health Messages
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 12,000 participants
- Where
- 1 siteSingapore
- Study dates
- 16 Sep 2024to 30 Sep 2025
- Phase
- Interventional
- Are there results?
- Yes, posted in the registrySummary in the doctors' view
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 50 to 69 years
- Women only
- Healthy volunteers accepted
- Adult, Older adult
Who may be able to join
- Singaporean citizen
- Age 50-69
- Registered as a patient at the National University Hospital
- Registered and active user of OneNUHS App
- Signed up with Healthier SG with a primary care provider within the NUHS Primary Care Network
Who cannot join
- Diagnosis of breast cancer in EPIC
- Mammogram done in the past 24 months in EPIC
Trial locations and contacts
1 site in 1 country.
About this study
Official title: Pragmatic Randomized Trial to Evaluate the Impact of Various Interventions to Increase the Uptake of Surveillance Mammography in Eligible Women in Singapore
Breast cancer is the most common cancer among women in Singapore, with more than 70 women out of every 100,000 being diagnosed each year. Early detection through regular mammograms can significantly reduce deaths from breast cancer. Although Singapore has had a national breast cancer screening program (now part of the Screen for Life initiative) for over 20 years, and the government offers substantial subsidies to make screening more affordable, participation remains low at only 30-40%. This low uptake is due to factors like fear, lack of awareness, cultural beliefs, and a perceived low risk of breast cancer. To be effective on a large scale, at least 70% of women need to participate in regular mammography screenings. While researchers in Singapore and Asia have studied the reasons behind low screening rates, there is still a lack of large-scale studies that test different strategies to increase mammography participation in these regions.
This trial will recruit 12,000 women aged 50-69 who have not undergone a mammogram in the past two years. 9000 women will be randomized into five intervention arms. The interventions include: direct mail reminder (Arm 1, control, n=3000), financial incentive (Arm 2, n=1500), lottery incentive (Arm 3, n=1500), health messaging from an influential figure (Arm 4, n=1500), and personal health concierge for appointment scheduling (Arm 5, n=1500). Another 3000 women will be placed in a non-interventional arm (NI arm) for observational analysis, that receives no reminders at all. A post-intervention telephone survey will assess intervention effectiveness.
Read more
The primary outcome is mammogram uptake across intervention arms with Arm 1 as a reference. Secondary outcome will be to compare Arm 1 with NI arm. Subgroup analyses will evaluate differences in uptake by sociodemographic factors, such as ethnicity and socioeconomic status. A cost-effectiveness analysis will assess the financial viability of each intervention.
This is the first large-scale study in Singapore and Asia to compare multiple interventions to boost mammography uptake. Findings will provide evidence-based strategies to improve breast cancer screening participation, potentially reducing breast cancer mortality and informing future public health policy.
Read the detailed description
This study aims to evaluate different interventions to boost breast cancer screening (mammography) participation among women in Singapore, aged 50-69, using data from the National University Health System (NUHS). 9000 eligible women will be randomized into one control arm and four experimental arms, receiving different combinations of reminders and incentives. Another 3000 women will be placed in an observational arm that receives no reminders at all. The study will use data from the NUHS electronic health records (EPIC) and NUHS app to monitor mammogram completion rates, exploring the effectiveness of each intervention.
Study Arms:
Control Group (Direct Mail Reminder): Receives a mail reminder with basic information about breast cancer and instructions on scheduling a mammogram.
Financial Incentive Group: Mail reminder + a $10 voucher for completing a mammogram within three months.
Lottery Incentive Group: Mail reminder + chance to win a $5000 lottery for completing the screening within three months.
Health Messaging Group: Mail reminder + QR code to a 60-second video from an influential person, available in four languages (English, Chinese, Malay, Tamil).
Personal Health Concierge Group: Mail reminder + a dedicated hotline for scheduling mammogram with the help of a health concierge over eight weeks.
Selection and Randomization:
Eligible participants will be selected from over 500,000 registered users of the OneNUHS app. Randomization will be done using a random number generator, with control and experimental arms receiving a 2:1 ratio. Data collected include basic demographic details and mammogram history, extracted securely from the EPIC system.
Data Collection:
Women in each arm will receive a physical mailer and three push notifications over three weeks, instructing them to schedule a mammogram at any approved screening center. Data on mammogram attendance will be extracted from EPIC post-study, and a subset of participants will be surveyed to gather feedback.
Primary and Secondary Endpoints:
The study will compare mammogram participation rates between the control and experimental arms, with secondary analyses exploring the uptake rates of arm 1 and NI arm as well as, impact of ethnicity, age, and income (via housing type) on outcomes. Additionally, a cost-effectiveness analysis will assess the impact of interventions on breast cancer detection and healthcare savings.
Follow-up and Evaluation:
A post-trial telephone survey of 750 participants will gather insights into their response to the interventions. The study aims to provide actionable insights into effective, scalable interventions to improve mammography uptake and reduce breast cancer mortality in Singapore.
- Being tested
- Financial intervention, Lottery intervention, Health Messages, Personal Health Concierge, Only reminder mailer
- Keywords
- Breast Neoplasms, Mammography
- Medical subject headings
- Breast Neoplasms
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Financial interventionOther
Participants completing the mammogram within the study end date will receive a $10 voucher.
Lottery interventionOther
Participants completing the mammogram within the study end date will receive a chance to win a $5000 lottery.
Health MessagesOther
Participants will receive a less than 5 minute long video from an influential person. The video will be available in four languages (English, Chinese, Malay, Tamil).
Personal Health ConciergeOther
Participants will be able to call a dedicated hotline for scheduling mammograms with the help of a health concierge over eight weeks of receive the the mailer.
Only reminder mailerOther
Receives a mail reminder with basic information about breast cancer and instructions on scheduling a mammogram.
| Study group | Role | What they receive |
|---|---|---|
| Observational Arm | No intervention | Does not receive any mailer reminder to go for mammogram. |
| Arm 1 (control) | Experimental | Receives a mail reminder with basic information about breast cancer and instructions on scheduling a mammogram Receives: Other: Only reminder mailer |
| Arm 2: Financial incentive | Experimental | Receives mail reminder + a $10 voucher for completing a mammogram within three months. Receives: Other: Financial intervention |
| Arm 3: Lottery incentive | Experimental | Receives mail reminder + chance to win a $5000 lottery for completing the screening within three months. Receives: Other: Lottery intervention |
| Arm 4: Health messaging | Experimental | Receives mail reminder + QR code to a 60-second video from an influential person, available in four languages (English, Chinese, Malay, Tamil). Receives: Other: Health Messages |
| Arm 5: Personal Health Concierge | Experimental | Receives mail reminder + a dedicated hotline for scheduling mammograms with the help of a health concierge over eight weeks. Receives: Other: Personal Health Concierge |
What is being measured
The primary outcome is the main question the study is designed to answer.
Comparison of Mammogram Uptake Between Intervention Arms (2-5) and Control Arm (Arm 1)
Primary endpoint: Comparison of the proportion of women who undergo surveillance mammography among participants in Arms 2-5 versus Arm 1 (control arm).
Measured: 4 months from randomization
Secondary outcomes (1)
Comparison of Mammogram Uptake Between Non-Interventional Arm (NI Arm) vs Control Arm (Arm 1)
Comparison of the proportion of women who undergo surveillance mammography among participants in Non-Interventional Arm (NI arm) versus Arm 1 (control arm).
Measured: 4 months from randomization
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted13 Dec 2024
- Study start16 Sep 2024
- Primary completion31 Dec 2024
- Study completion30 Sep 2025
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Posted resultsParticipant flow, outcome measures and adverse events reported by the sponsor.
- Publications (2)Papers the sponsor has linked to this study.
- Other trials for This Study Evaluates Interventions to Increase Surveillance Mammography Uptake for Early Breast Cancer Detection Among Singaporean WomenStudies of the same condition, open and under way.
- More trials run by National University Hospital, SingaporeThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Prevention
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Model description
- This study follows a parallel assignment model where participants are randomly assigned to one of five distinct arms: a control arm or one of four intervention arms. Each arm receives a different intervention, and the effects are compared to assess the impact on the uptake of surveillance mammography.
- Masking
- None (open label)
- Enrolment
- 12,000 participants (actual)
Sponsor and investigators
- Lead sponsor
- National University Hospital, Singapore
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT06733155
- Sponsor's protocol ID
- 2023/01007
- Other IDs
- 2023
- Status last verified
- Oct 2024
- First submitted
- 10 Dec 2024
- Last updated
- 7 Jul 2026
- Results posted
- Yes, on ClinicalTrials.gov
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Publications
Lucky SS, Li W, Ow SGW, Loh L, Tan JH, Goh BC, Lee SC. Reminder recall is associated with higher mammogram uptake among overdue repeat screeners: an exploratory telephone survey within a randomized trial. BMC Med. 2026 Jul 31;24(1):601. doi: 10.1186/s12916-026-05112-3.
PubMed 42972567Lee SC, Lucky SS, Zhu J, Ow S, Loh L, Tan JH, Lim SE, Hairom Z, Mehta S, Tai BC, Goh BC. Pragmatic Interventions to Boost Surveillance Mammogram Uptake Among an Overdue Population: A Randomized Clinical Trial. JAMA Intern Med. 2026 Jan 1;186(1):27-35. doi: 10.1001/jamainternmed.2025.5873.
PubMed 41212556
Study at a glance
From the registry record, last updated by the sponsor on 7 Jul 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Pragmatic Randomized Trial to Evaluate the Impact of Various Interventions to Increase the Uptake of Surveillance Mammography in Eligible Women in Singapore
- ClinicalTrials.gov ID
- NCT06733155
- Acronym / sponsor ID
- 2023/01007
- Keywords
- Breast Neoplasms, Mammography
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 12,000 participants (actual)
- Lead sponsor
- National University Hospital, SingaporeUniversity, hospital or other
- Study start
- 16 Sep 2024 (actual)
- Primary completion
- 31 Dec 2024 (actual)
- Study completion
- 30 Sep 2025 (actual)
- First posted
- 13 Dec 2024 (actual)
- Results
- Posted 7 Jul 2026
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Breast cancer is the most common cancer among women in Singapore, with more than 70 women out of every 100,000 being diagnosed each year. Early detection through regular mammograms can significantly reduce deaths from breast cancer. Although Singapore has had a national breast cancer screening program (now part of the Screen for Life initiative) for over 20 years, and the government offers substantial subsidies to make screening more affordable, participation remains low at only 30-40%. This low uptake is due to factors like fear, lack of awareness, cultural beliefs, and a perceived low risk of breast cancer. To be effective on a large scale, at least 70% of women need to participate in regular mammography screenings. While researchers in Singapore and Asia have studied the reasons behind low screening rates, there is still a lack of large-scale studies that test different strategies to increase mammography participation in these regions.
This trial will recruit 12,000 women aged 50-69 who have not undergone a mammogram in the past two years. 9000 women will be randomized into five intervention arms. The interventions include: direct mail reminder (Arm 1, control, n=3000), financial incentive (Arm 2, n=1500), lottery incentive (Arm 3, n=1500), health messaging from an influential figure (Arm 4, n=1500), and personal health concierge for appointment scheduling (Arm 5, n=1500). Another 3000 women will be placed in a non-interventional arm (NI arm) for observational analysis, that receives no reminders at all. A post-intervention telephone survey will assess intervention effectiveness.
The primary outcome is mammogram uptake across intervention arms with Arm 1 as a reference. Secondary outcome will be to compare Arm 1 with NI arm. Subgroup analyses will evaluate differences in uptake by sociodemographic factors, such as ethnicity and socioeconomic status. A cost-effectiveness analysis will assess the financial viability of each intervention.
This is the first large-scale study in Singapore and Asia to compare multiple interventions to boost mammography uptake. Findings will provide evidence-based strategies to improve breast cancer screening participation, potentially reducing breast cancer mortality and informing future public health policy.
Detailed description
This study aims to evaluate different interventions to boost breast cancer screening (mammography) participation among women in Singapore, aged 50-69, using data from the National University Health System (NUHS). 9000 eligible women will be randomized into one control arm and four experimental arms, receiving different combinations of reminders and incentives. Another 3000 women will be placed in an observational arm that receives no reminders at all. The study will use data from the NUHS electronic health records (EPIC) and NUHS app to monitor mammogram completion rates, exploring the effectiveness of each intervention.
Study Arms:
Control Group (Direct Mail Reminder): Receives a mail reminder with basic information about breast cancer and instructions on scheduling a mammogram.
Financial Incentive Group: Mail reminder + a $10 voucher for completing a mammogram within three months.
Lottery Incentive Group: Mail reminder + chance to win a $5000 lottery for completing the screening within three months.
Health Messaging Group: Mail reminder + QR code to a 60-second video from an influential person, available in four languages (English, Chinese, Malay, Tamil).
Personal Health Concierge Group: Mail reminder + a dedicated hotline for scheduling mammogram with the help of a health concierge over eight weeks.
Selection and Randomization:
Eligible participants will be selected from over 500,000 registered users of the OneNUHS app. Randomization will be done using a random number generator, with control and experimental arms receiving a 2:1 ratio. Data collected include basic demographic details and mammogram history, extracted securely from the EPIC system.
Data Collection:
Women in each arm will receive a physical mailer and three push notifications over three weeks, instructing them to schedule a mammogram at any approved screening center. Data on mammogram attendance will be extracted from EPIC post-study, and a subset of participants will be surveyed to gather feedback.
Primary and Secondary Endpoints:
The study will compare mammogram participation rates between the control and experimental arms, with secondary analyses exploring the uptake rates of arm 1 and NI arm as well as, impact of ethnicity, age, and income (via housing type) on outcomes. Additionally, a cost-effectiveness analysis will assess the impact of interventions on breast cancer detection and healthcare savings.
Follow-up and Evaluation:
A post-trial telephone survey of 750 participants will gather insights into their response to the interventions. The study aims to provide actionable insights into effective, scalable interventions to improve mammography uptake and reduce breast cancer mortality in Singapore.
Study design
- Primary purpose
- Prevention
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 6
- Model description
- This study follows a parallel assignment model where participants are randomly assigned to one of five distinct arms: a control arm or one of four intervention arms. Each arm receives a different intervention, and the effects are compared to assess the impact on the uptake of surveillance mammography.
| Arm | Type | Receives |
|---|---|---|
| Observational Arm | No intervention | –Does not receive any mailer reminder to go for mammogram. |
| Arm 1 (control) | Experimental | Other: Only reminder mailerReceives a mail reminder with basic information about breast cancer and instructions on scheduling a mammogram |
| Arm 2: Financial incentive | Experimental | Other: Financial interventionReceives mail reminder + a $10 voucher for completing a mammogram within three months. |
| Arm 3: Lottery incentive | Experimental | Other: Lottery interventionReceives mail reminder + chance to win a $5000 lottery for completing the screening within three months. |
| Arm 4: Health messaging | Experimental | Other: Health MessagesReceives mail reminder + QR code to a 60-second video from an influential person, available in four languages (English, Chinese, Malay, Tamil). |
| Arm 5: Personal Health Concierge | Experimental | Other: Personal Health ConciergeReceives mail reminder + a dedicated hotline for scheduling mammograms with the help of a health concierge over eight weeks. |
Who may qualify
- Ages
- 50 to 69 years
- Sex
- Female only
- Healthy volunteers
- Accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (5 listed)
- Singaporean citizen
- Age 50-69
- Registered as a patient at the National University Hospital
- Registered and active user of OneNUHS App
- Signed up with Healthier SG with a primary care provider within the NUHS Primary Care Network
Key exclusion criteria (2 listed)
- Diagnosis of breast cancer in EPIC
- Mammogram done in the past 24 months in EPIC
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Financial interventionParticipants completing the mammogram within the study end date will receive a $10 voucher. | Other | Arm 2: Financial incentive |
| Lottery interventionParticipants completing the mammogram within the study end date will receive a chance to win a $5000 lottery. | Other | Arm 3: Lottery incentive |
| Health MessagesParticipants will receive a less than 5 minute long video from an influential person. The video will be available in four languages (English, Chinese, Malay, Tamil). | Other | Arm 4: Health messaging |
| Personal Health ConciergeParticipants will be able to call a dedicated hotline for scheduling mammograms with the help of a health concierge over eight weeks of receive the the mailer. | Other | Arm 5: Personal Health Concierge |
| Only reminder mailerReceives a mail reminder with basic information about breast cancer and instructions on scheduling a mammogram. | Other | Arm 1 (control) |
Primary outcome
Comparison of Mammogram Uptake Between Intervention Arms (2-5) and Control Arm (Arm 1)
Time frame: 4 months from randomization
Primary endpoint: Comparison of the proportion of women who undergo surveillance mammography among participants in Arms 2-5 versus Arm 1 (control arm).
1 secondary outcome
Comparison of Mammogram Uptake Between Non-Interventional Arm (NI Arm) vs Control Arm (Arm 1)
Time frame: 4 months from randomization
Results and safety
Loading the posted results from ClinicalTrials.gov…
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 7 Jul 2026.
- Posted resultsParticipant flow, baseline, all outcome measures and adverse events.
- Derived from this study: PubMed 42972567Lucky SS, Li W, Ow SGW, Loh L, Tan JH, Goh BC, Lee SC. Reminder recall is associated with higher mammogram uptake among overdue repeat screeners: an exploratory telephone survey within a randomized trial. BMC Med. 2026 Jul 31;24(1):601. doi: 10.1186/s12916-026-05112-3.
- Derived from this study: PubMed 41212556Lee SC, Lucky SS, Zhu J, Ow S, Loh L, Tan JH, Lim SE, Hairom Z, Mehta S, Tai BC, Goh BC. Pragmatic Interventions to Boost Surveillance Mammogram Uptake Among an Overdue Population: A Randomized Clinical Trial. JAMA Intern Med. 2026 Jan 1;186(1):27-35. doi: 10.1001/jamainternmed.2025.5873.
- Individual participant dataSharing planned: No
Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
The record lists no contact. Use the official record to reach the sponsor.
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Financial intervention, Lottery intervention and Health Messages in people with This Study Evaluates Interventions to Increase Surveillance Mammography Uptake for Early Breast Cancer Detection Among Singaporean Women, run by National University Hospital, Singapore at 1 site in Singapore.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 5 inclusion and 2 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 7 Jul 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Singapore. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
Yes. Results are posted in the registry (first posted 7 Jul 2026). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Comparison of Mammogram Uptake Between Intervention Arms (2-5) and Control Arm (Arm 1) (time frame: 4 months from randomization). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT06733155, which also lists 2 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 7 Jul 2026.