Impact of Improved Screening Mammography Recall Lay Letter Readability on Patient Follow-Up

Derek L. Nguyen, Susan C. Harvey, Eniola T. Oluyemi, Kelly S. Myers, Lisa A. Mullen, Emily B. Ambinder

Research output: Contribution to journalArticlepeer-review


Purpose: In the setting of abnormal results on screening mammography, the Mammography Quality Standards Act mandates that patients receive a mailed “recall” lay letter informing them to return for additional follow-up imaging. The language used in this letter should be “easily understood by a lay person.” In February 2019, the authors’ institution revised the language of its recall lay letter to the sixth grade reading level. The purpose of this study was to analyze the effect of improved readability on patient follow-up rates. Methods: In this retrospective study, data from all screening mammograms at a single institution with BI-RADS category 0 assessments excluding technical recalls between February 2018 to February 2019 (pre-intervention group) and February 2019 to February 2020 (post-intervention group) were reviewed. The primary outcome measure was the percentage of patients in each intervention group who returned for their diagnostic follow-up examination within 60 days (the standard recommended by the Centers for Disease Control and Prevention). Univariate and multivariate logistic regression was done to estimate odds ratios and 95% confidence intervals for follow-up within 60 days. Results: This study included 1,987 patients in the pre-intervention group and 2,211 patients in the post-intervention group. The patient follow-up rate within 60 days increased from 90.1% (1,790 of 1,987) in the pre-intervention group to 93.9% (2,076 of 2,211) in the post-intervention group (P < .001). When controlling for imaging site, patients in the post-intervention group had 1.96-fold increased odds of returning for a diagnostic follow-up examination within 60 days (95% confidence interval, 1.52-2.53). Conclusions: Revising an institution's recall lay letter to a lower reading grade level significantly improved timely patient follow-up.

Original languageEnglish (US)
Pages (from-to)1429-1436
Number of pages8
JournalJournal of the American College of Radiology
Issue number11
StatePublished - Nov 2020


  • Educational disparities
  • lay letter
  • patient adherence
  • readability
  • recall
  • screening mammography

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


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