Burns and colleagues [1] should be congratulated on successfully completing a truly massive study. We are also interested in improving use of screening mammography in underserved populations.

Burns and colleagues confirm our limited local experience [2, 3] of distressingly low rates of mammography use among some women. We are investigating reasons for this by conducting series of patient interviews to identify specific barriers, facilitators, attitudes, and knowledge about mammography. Educational factors appear to be particularly important. Many practitioners and institutions rely on brochures to provide education about mammography, brochures that many women may not be able to read. Cultural and peer group factors also seem important. A common sentiment our patients express is, "I knew someone who had a mammogram once and before I knew it she was dead from breast cancer. If I have it I don't want to know."

We believe that programs to improve use of screening mammography in underserved populations should address more than the usual barriers of cost, convenience, transportation, and access to medical care. Education should be provided in one-on-one or small-group settings. Brief videotapes depicting peers of the target group may be useful, as may be the use of peer educators. In addition, such interventions as educational efforts and the actual provision of mammography using portable units can be provided in community-based locations, such as churches, schools, and even grocery stores. Appropriate follow-up can be difficult with such community outreach but is usually possible with proper planning. We plan to study such a program and evaluate whether or not such interventions will improve use of screening mammography in our area.