This Study Evaluates Interventions to Increase Surveillance Mammography Uptake for Early Breast Cancer Detection Among Singaporean WomenPROMPTNCT07283107
Trial to Evaluate the Impact of Various Behavioural Interventions to Increase Mammography Uptake Among Singaporean Women
A study testing Arm 2: One mailed reminder, Arm 3: Two mailed reminders and Arm 4: Mailed reminder with prescheduled appointment 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 leading cancer among women in Singapore, yet mammography screening rates remain critically low at 34.7%, despite the availability of a national program since 2002. This shortfall significantly limits the potential of screening to reduce mortality at a population level. 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?
- Arm 2: One mailed reminder, Arm 3: Two mailed reminders and Arm 4: Mailed reminder with prescheduled appointment
- Type of treatment
- Lifestyle or therapy programme
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 8,910 participants
- Where
- 1 siteSingapore
- Study dates
- 17 Nov 2025to 31 Dec 2027
- Phase
- Interventional
- Are there results?
- Not yet: the study is under way
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 NUHS App
- Signed up with Healthier SG with a primary care provider within the NUHS Primary Care Network
- For "never-screener" cohort: Must have never undergone mammogram screening
- For "repeat-screener" cohort : Must have completed screening in the last 18-24 months but have not booked their next appointment yet
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. Contact the study team or a site near you to ask about taking part.
About this study
Official title: Two Parallel Randomized Controlled Trials to Evaluate Outreach Strategies for Increasing Mammogram Uptake in Women Who Have Never Screened or Are Due for Repeat Screening
Breast cancer is the leading cancer among women in Singapore, yet mammography screening rates remain critically low at 34.7%, despite the availability of a national program since 2002. This shortfall significantly limits the potential of screening to reduce mortality at a population level. While various behavioral interventions have been tested internationally to increase uptake, their applicability in the local context remains uncertain. Existing studies in Singapore are either outdated, small in scale, or not sufficiently targeted. In particular, two subgroups of women warrant closer examination due to the scarcity of data: (1) never-screeners: those who have never undergone a mammogram and (3) recent screeners: those who had a mammogram more than two years ago but have not scheduled their next one. These cohorts exhibit distinct behavioral and psychological barriers that prevent adherence to regular, guideline-recommended screening. E.g., key barriers for never- screeners include low perceived susceptibility to breast cancer, lack of awareness about the benefits of early detection, fear or anxiety about pain or receiving a cancer diagnosis, cultural or personal modesty concerns or lack of a physician's recommendation. In contrast, the repeat recent screeners often have a misconception that a single normal result is sufficient, negative experiences during prior screenings (e.g., false positives, pain), absence of reminder systems and competing life priorities and lack of time. Among these, engaging never-screeners is particularly challenging, as they may not perceive screening as personally relevant or necessary, and many have successfully avoided the healthcare system for years. Yet, failure to engage these groups; poses a significant public health concern, as it undermines the effectiveness of population-level cancer control strategies. The PROMPT study is designed to fill this critical gap by systematically evaluating multiple low-cost, scalable outreach strategies in two parallel randomized trials. Its findings will provide robust, local evidence to inform policy and improve engagement of these hard-to-reach populations.
Read the detailed description
The study comprises two parallel randomized controlled trials targeting two distinct populations: (1) Women who have never undergone a mammogram ("Never Screeners"): Eligibility criteria- Singaporean women, aged 50-69, who are eligible for free biennial mammograms but have not gone for mammogram yet, with no history of prior breast cancer, will be identified using the NUH electronic medical health records system (EPIC). The selection will be restricted to NUHS patients who are registered users of the NUHS App. To further select/narrow down the eligible participants, app-activity/ last login date will be used (Active app user is defined as having used the app at least once within 12 months of the study start date. If there are not enough active NUHS app user, the last login interval will be increased to 18 to 24 months until sufficient eligible participants are obtained. If the last login needs to be extended beyond 24 months, IRB approval will be sought). The required 3,000 patients for the study will be randomly selected from these eligible patients.(2) Women who have undergone mammogram in the past 2 years but not scheduled a repeat screening yet ("Recent Screeners"): Eligibility criteria- Singaporean women, aged 50-69, who are eligible for free biennial mammograms and have gone for mammogram in the past 18-24 months but have not scheduled an appointment for repeat screening yet, with no history of prior breast cancer, will be identified using the NUH electronic medical health records system (EPIC). Selection will be restricted to NUHS patients who are registered users of the NUHS App (as defined above). The required 5,910 patients for the study will be randomly selected from these eligible patients.
The study will enroll a total of 3000 never-screeners (600 participants in each arm) and 5910 recent screeners (1182 participants in each arm) across 5 intervention groups. Sample size calculations were performed to ensure 90% power at a two-sided significance level of 5% (α = 0.05) to detect a clinically meaningful difference in the primary outcome, defined as an absolute increase of 7% in mammogram uptake. The study employs a ≥"pick-the-winner" design, wherein each intervention arm (Arms 2-5) is compared individually against the control arm (Arm 1). An intervention will be considered successful if it demonstrates at least a 7% absolute improvement in uptake relative to the control.
Statistical analysis plan: Pairwise comparisons between each intervention arm (Arms 2-5) and the control arm (Arm 1) will be performed using logistic regression to estimate the odds ratios (ORs), absolute differences in proportions, and 95% confidence intervals (CIs) for mammogram uptake.
Primary endpoint: All data on mammogram completion will be obtained from existing sources such as electronic medical records and the national screening registry. The primary outcome is mammogram uptake within four months of the first intervention (date of sending the mailer/ push notification, whichever is later). Uptake data might be also extracted at the 6 and 12 month time-point to see if there was any additional uptake. These extended follow-up points will allow for the assessment of any delayed uptake, which may help to understand the longer-term impact of the interventions. No new clinical data will be generated from participants. Screening behavior will be assessed through electronic medical record (EMR) review, specifically from the National University Health System's (NUHS) mammography booking and screening databases (the national screening registry). Data extracted will include mammogram booking and attendance status, date of screening (if any), and relevant demographic details. All data on mammogram completion will be obtained from existing sources such as electronic medical records. Findings will provide evidence-based strategies to improve breast cancer screening participation, potentially reducing breast cancer mortality and informing future public health policy.
- Being tested
- Arm 2: One mailed reminder, Arm 3: Two mailed reminders, Arm 4: Mailed reminder with prescheduled appointment, Arm 5: Mailed reminder with enhanced messaging
- Keywords
- Mammography, Breast Cancer, Cancer Screening, Early Cancer Detection
- Medical subject headings
- Breast Neoplasms
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Arm 2: One mailed reminderBehavioural
Receives a mailed reminder with basic information about breast cancer and instructions on scheduling a mammogram
Arm 3: Two mailed remindersBehavioural
Receives a mailed reminder + follow-up mailed reminder, 1 month after the first reminder
Arm 4: Mailed reminder with prescheduled appointmentBehavioural
Receives one mailed reminder with a pre-scheduled appointment, with instructions to change appointment
Arm 5: Mailed reminder with enhanced messagingBehavioural
Receives one mailed reminder with enhanced messaging motivating recipient to undergo screening
| Study group | Role | What they receive |
|---|---|---|
| Control Arm (Arm 1) | No intervention | Does not receive any reminder to go for mammogram. |
| Arm 2: : One mailed reminder | Experimental | Receives a single mail reminder Receives: Behavioral: Arm 2: One mailed reminder |
| Arm 3: Two mailed reminders | Experimental | Receives two mail reminders, 1 month apart Receives: Behavioral: Arm 3: Two mailed reminders |
| Arm 4: Mailed Reminder with Prescheduled Appointment | Experimental | Recieves a mailed reminder with prescheduled appointment Receives: Behavioral: Arm 4: Mailed reminder with prescheduled appointment |
| Arm 5: Mailed reminder with enhanced messaging | Experimental | Receives mailed reminder with enhanced messaging Receives: Behavioral: Arm 5: Mailed reminder with enhanced messaging |
What is being measured
The primary outcome is the main question the study is designed to answer.
Comparison of Mammogram Uptake Between Interventional Arms (2-5) and Control Arm (Arm 1)
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 the time participants receive the reminders
Secondary outcomes (3)
Impact of social and demographic factors on mammogram completion.
Impact of ethnicity, age, and income (via housing type) on outcomes will be assessed
Measured: 4 months from the time participants receive the reminder
Post-trial telephone survey
A post-trial telephone survey of 750 participants for each cohort (never screeners and repeat screeners) 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.
Measured: 1-2 months post-trial
Mammogram uptake at 6 and 12 months post-trial
Comparison of mammogram completion 6 and 12 months after the initial study
Measured: 6 and 12 months from the time participants received the first mailed reminder
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted15 Dec 2025
- Study start17 Nov 2025
- Primary completion31 Dec 2026 (estimated)
- Study completion31 Dec 2027 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- 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.
- 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
- Screening
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Enrolment
- 8,910 participants (estimated)
Sponsor and investigators
- Lead sponsor
- National University Hospital, Singapore
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
- Investigators
- Soo-Chin Lee, MBBS, MRCP, Principal investigator, National University Hospital Singapore, Singapore
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07283107
- Sponsor's protocol ID
- 2025-0880
- Acronym
- PROMPT
- Status last verified
- Dec 2025
- First submitted
- 2 Dec 2025
- Last updated
- 29 Dec 2025
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Study at a glance
From the registry record, last updated by the sponsor on 29 Dec 2025. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Two Parallel Randomized Controlled Trials to Evaluate Outreach Strategies for Increasing Mammogram Uptake in Women Who Have Never Screened or Are Due for Repeat Screening
- ClinicalTrials.gov ID
- NCT07283107
- Acronym / sponsor ID
- PROMPT / 2025-0880
- Keywords
- Mammography, Breast Cancer, Cancer Screening, Early Cancer Detection
- Study type
- Interventional
- Recruitment status
- Enrolling by invitation
- Enrolment
- 8,910 participants (estimated)
- Lead sponsor
- National University Hospital, SingaporeUniversity, hospital or other
- Study start
- 17 Nov 2025 (actual)
- Primary completion
- 31 Dec 2026 (estimated)
- Study completion
- 31 Dec 2027 (estimated)
- First posted
- 15 Dec 2025 (actual)
- Results
- Not posted in the source record
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 leading cancer among women in Singapore, yet mammography screening rates remain critically low at 34.7%, despite the availability of a national program since 2002. This shortfall significantly limits the potential of screening to reduce mortality at a population level. While various behavioral interventions have been tested internationally to increase uptake, their applicability in the local context remains uncertain. Existing studies in Singapore are either outdated, small in scale, or not sufficiently targeted. In particular, two subgroups of women warrant closer examination due to the scarcity of data: (1) never-screeners: those who have never undergone a mammogram and (3) recent screeners: those who had a mammogram more than two years ago but have not scheduled their next one. These cohorts exhibit distinct behavioral and psychological barriers that prevent adherence to regular, guideline-recommended screening. E.g., key barriers for never- screeners include low perceived susceptibility to breast cancer, lack of awareness about the benefits of early detection, fear or anxiety about pain or receiving a cancer diagnosis, cultural or personal modesty concerns or lack of a physician's recommendation. In contrast, the repeat recent screeners often have a misconception that a single normal result is sufficient, negative experiences during prior screenings (e.g., false positives, pain), absence of reminder systems and competing life priorities and lack of time. Among these, engaging never-screeners is particularly challenging, as they may not perceive screening as personally relevant or necessary, and many have successfully avoided the healthcare system for years. Yet, failure to engage these groups; poses a significant public health concern, as it undermines the effectiveness of population-level cancer control strategies. The PROMPT study is designed to fill this critical gap by systematically evaluating multiple low-cost, scalable outreach strategies in two parallel randomized trials. Its findings will provide robust, local evidence to inform policy and improve engagement of these hard-to-reach populations.
Detailed description
The study comprises two parallel randomized controlled trials targeting two distinct populations: (1) Women who have never undergone a mammogram ("Never Screeners"): Eligibility criteria- Singaporean women, aged 50-69, who are eligible for free biennial mammograms but have not gone for mammogram yet, with no history of prior breast cancer, will be identified using the NUH electronic medical health records system (EPIC). The selection will be restricted to NUHS patients who are registered users of the NUHS App. To further select/narrow down the eligible participants, app-activity/ last login date will be used (Active app user is defined as having used the app at least once within 12 months of the study start date. If there are not enough active NUHS app user, the last login interval will be increased to 18 to 24 months until sufficient eligible participants are obtained. If the last login needs to be extended beyond 24 months, IRB approval will be sought). The required 3,000 patients for the study will be randomly selected from these eligible patients.(2) Women who have undergone mammogram in the past 2 years but not scheduled a repeat screening yet ("Recent Screeners"): Eligibility criteria- Singaporean women, aged 50-69, who are eligible for free biennial mammograms and have gone for mammogram in the past 18-24 months but have not scheduled an appointment for repeat screening yet, with no history of prior breast cancer, will be identified using the NUH electronic medical health records system (EPIC). Selection will be restricted to NUHS patients who are registered users of the NUHS App (as defined above). The required 5,910 patients for the study will be randomly selected from these eligible patients.
The study will enroll a total of 3000 never-screeners (600 participants in each arm) and 5910 recent screeners (1182 participants in each arm) across 5 intervention groups. Sample size calculations were performed to ensure 90% power at a two-sided significance level of 5% (α = 0.05) to detect a clinically meaningful difference in the primary outcome, defined as an absolute increase of 7% in mammogram uptake. The study employs a ≥"pick-the-winner" design, wherein each intervention arm (Arms 2-5) is compared individually against the control arm (Arm 1). An intervention will be considered successful if it demonstrates at least a 7% absolute improvement in uptake relative to the control.
Statistical analysis plan: Pairwise comparisons between each intervention arm (Arms 2-5) and the control arm (Arm 1) will be performed using logistic regression to estimate the odds ratios (ORs), absolute differences in proportions, and 95% confidence intervals (CIs) for mammogram uptake.
Primary endpoint: All data on mammogram completion will be obtained from existing sources such as electronic medical records and the national screening registry. The primary outcome is mammogram uptake within four months of the first intervention (date of sending the mailer/ push notification, whichever is later). Uptake data might be also extracted at the 6 and 12 month time-point to see if there was any additional uptake. These extended follow-up points will allow for the assessment of any delayed uptake, which may help to understand the longer-term impact of the interventions. No new clinical data will be generated from participants. Screening behavior will be assessed through electronic medical record (EMR) review, specifically from the National University Health System's (NUHS) mammography booking and screening databases (the national screening registry). Data extracted will include mammogram booking and attendance status, date of screening (if any), and relevant demographic details. All data on mammogram completion will be obtained from existing sources such as electronic medical records. Findings will provide evidence-based strategies to improve breast cancer screening participation, potentially reducing breast cancer mortality and informing future public health policy.
Study design
- Primary purpose
- Screening
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 5
| Arm | Type | Receives |
|---|---|---|
| Control Arm (Arm 1) | No intervention | –Does not receive any reminder to go for mammogram. |
| Arm 2: : One mailed reminder | Experimental | Behavioral: Arm 2: One mailed reminderReceives a single mail reminder |
| Arm 3: Two mailed reminders | Experimental | Behavioral: Arm 3: Two mailed remindersReceives two mail reminders, 1 month apart |
| Arm 4: Mailed Reminder with Prescheduled Appointment | Experimental | Behavioral: Arm 4: Mailed reminder with prescheduled appointmentRecieves a mailed reminder with prescheduled appointment |
| Arm 5: Mailed reminder with enhanced messaging | Experimental | Behavioral: Arm 5: Mailed reminder with enhanced messagingReceives mailed reminder with enhanced messaging |
Who may qualify
- Ages
- 50 to 69 years
- Sex
- Female only
- Healthy volunteers
- Accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (7 listed)
- Singaporean citizen
- Age 50-69
- Registered as a patient at the National University Hospital
- Registered and active user of NUHS 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 |
|---|---|---|
| Arm 2: One mailed reminderReceives a mailed reminder with basic information about breast cancer and instructions on scheduling a mammogram | Behavioural | Arm 2: : One mailed reminder |
| Arm 3: Two mailed remindersReceives a mailed reminder + follow-up mailed reminder, 1 month after the first reminder | Behavioural | Arm 3: Two mailed reminders |
| Arm 4: Mailed reminder with prescheduled appointmentReceives one mailed reminder with a pre-scheduled appointment, with instructions to change appointment | Behavioural | Arm 4: Mailed Reminder with Prescheduled Appointment |
| Arm 5: Mailed reminder with enhanced messagingReceives one mailed reminder with enhanced messaging motivating recipient to undergo screening | Behavioural | Arm 5: Mailed reminder with enhanced messaging |
Primary outcome
Comparison of Mammogram Uptake Between Interventional Arms (2-5) and Control Arm (Arm 1)
Time frame: 4 months from the time participants receive the reminders
Comparison of the proportion of women who undergo surveillance mammography among participants in Arms 2-5 versus Arm 1 (control arm).
3 secondary outcomes
Impact of social and demographic factors on mammogram completion.
Time frame: 4 months from the time participants receive the reminder
Post-trial telephone survey
Time frame: 1-2 months post-trial
Mammogram uptake at 6 and 12 months post-trial
Time frame: 6 and 12 months from the time participants received the first mailed reminder
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 29 Dec 2025.
- Individual participant dataSharing planned: No
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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.
Soo-Chin Lee, MBBS, MRCP principal investigator
National University Hospital Singapore, Singapore
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Arm 2: One mailed reminder, Arm 3: Two mailed reminders and Arm 4: Mailed reminder with prescheduled appointment 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 7 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: enrolling by invitation, as of the sponsor's last update on 29 Dec 2025. 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?
This study is still under way. Results are not available in the source record yet.
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 Interventional Arms (2-5) and Control Arm (Arm 1) (time frame: 4 months from the time participants receive the reminders). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
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 29 Dec 2025; AzTrials last refreshed its copy on 26 Oct 2026.