I was 31 years old when my mother was dying of breast cancer. One day, while sitting with her in the hospital, her oncologist asked me a question no one had ever asked me before: “Have you had a mammogram yet?”
Even though my mother had been diagnosed with breast cancer when she was 34, I had never thought about getting a mammogram or discussed it with my doctor. The problem wasn’t that I didn’t have access to health care. The problem was that no one ever suggested that a mammogram was right for me, given my family history.
That points to a larger gap in communication in the U.S. health care system. Health care providers and public health officials must find ways to deliver simple, actionable messages about preventive care to people who need them.
Solving this problem couldn’t be more urgent. The U.S. Preventive Services Task Force recently released new guidelines lowering the age at which all women should regularly get a mammogram from 50 years to 40. According to the guidelines, some women — like me, based on their family history — should be screened for breast cancer even earlier.
I got my first mammogram soon after that discussion with my mother’s oncologist, and learned that I should have been getting mammograms since the age of 25. Cancer kills almost 1,700 Americans every day, but if caught early, many cancers, including breast cancer, can be treated so people are more likely to survive and have a better quality of life when they go through treatment.
But as many as two in five American adults don’t know they need to be checked for hidden cancer. Why? Because most people don’t regularly think about cancer screening, and only hear about it during a once-a-year appointment with their doctor. Many guidelines are based on one’s specific clinical profile and family history, and they change from time to time, making it harder to know when to get them. For example, in addition to the recently updated guidelines lowering the age at which women should start getting regular mammograms, the age for starting colorectal cancer screening has also been lowered. Awareness campaigns too often fall short of prompting people to have conversations with their doctors, schedule appointments, and get screened.
Part of the reason is that 20th century marketing tactics are being used to communicate about 21st century guidelines, and they aren’t working. In almost every part of daily life, people receive personalized messages when they need to take action. Book a hotel at the beach, for example, and you get notifications about flights, rental cars, or restaurants in the area. You can click on them and make the reservation right away, when you are actively planning your trip.
Public health messages are delivered in many ways, including TV ads or even TikTok campaigns, but people typically aren’t thinking about their health in those moments.
One of the times when people are actively thinking about their health is at medical appointments. Waiting rooms are often festooned with information about the latest public health guidance, from vaccines they may be eligible for to preventive measures to take. But the stack of pamphlets, posters on the wall, or TV screens on endless video loops are easy to ignore — because none of it is personalized to the reader or viewer.
That puts the burden of communicating preventive care guidelines on primary care providers, who already have too much to cover in short appointments, leaving little time to make sure their patients fully understand that guidance.
The CDC is trying to get public health messaging to patients through their trusted doctors, but it’s time to help providers shoulder this burden. Public health guidance needs to be delivered when people are engaged in their health, in a way that makes it easy to understand and simple to act.
What’s needed is better use of technology to deliver relevant messages that are private and tailored to individual’s needs when they can take action. In The Annals of Internal Medicine earlier this year, researchers called for this approach, citing work I led at Phreesia to deliver messages about vaccination to more than 20 million people while they were checking in for their medical visits on their phone or on a tablet at the doctor’s office. One-third of them indicated their intent to get the vaccine in a follow-up survey.
In my work with health care providers, I have seen this approach work in breast cancer prevention as well. One health system, for example, messaged more than 87,000 people by text or email about mammogram screenings, and 32% of them then requested a mammogram appointment.
The new guidelines about mammography and colorectal cancer screening will undoubtedly save lives, but only if people know about and can follow them. Relevant messages are especially important in this case because the guidelines depend on each person’s profile. When awareness campaigns are limited to brochures in a doctor’s office, TV ads, or even TikTok campaigns, people may not understand their individual risk and recommendations. The time is now to make it easier for people to understand what screenings they need and take preventive action.
Hilary Hatch, Ph.D. is the chief clinical officer at Phreesia, a company that gives providers, life sciences companies, payers and other organizations tools to help patients take a more active role in their care, and a member of the National Quality Foundation’s Leadership Consortium.