Multivariate logistic regression was used to obtain odds ratios between cases and controls. Main outcomes were symptoms of menopause, use of estrogen, and use of alternative therapies. RESULTS: Breast cancer survivors were 5.4 (95% CI 2.9 ± 10.4) times more likely to experience symptoms, 25 (95% CI 8.3 ± 100) times less likely to use estrogen, and 7.4 (95% CI 2.5 ± 21.9) times more likely to use alternatives than controls. Soy, vitamin E, and herbal remedies were the most common alternative therapies reported by participants; use was greater in cases compared to controls. Among cases, tamoxifen users (n=62) reported a higher prevalence of symptoms and a higher prevalence of alternative treatments. Most soy users reported increasing soy products specifically to reduce the chances of a diagnosis of recurrent breast cancer. CONCLUSION: This is the first population-based survey of menopausal symptoms and treatments that compares breast cancer cases with disease-free controls. Prevalence of menopausal symptoms and use of alternative menopausal therapies were higher in breast cancer survivors than in controls; the rate of estrogen use was much lower. The increased use of soy products in this population has not been previously documented. (2) Test the effect of a personalized letter directed to women who have not had a recent mammogram Ð reticent beneficiaries. (3) Assess the cost-effectiveness of the intervention. METHODS: HCFA data for Medicare beneficiaries were used to identify women living in Michigan continuously from 1993 ± 98, age !65 in 1993, with no obvious comorbidity affecting screening, and no mammogram for !5 years (1993 ± 97). A randomized design included paired intervention and control women matched on residential zipcode and race. The study sample of 2,458 women had 1,229 pairs of either African American (AA) or non-AA women and either urban or rural women. The intervention used principles from the Health Belief Model in a personally addressed letter from the Medical Director of Michigan Medicare noting the individual's lack of use of the mammography screening benefit, with additional breast cancer related information enclosed. Letters were sent in Nov. 1997 with Medicare mammography claims followed through 1998. RESULTS: All women were age !70, with a mean of 79 in both control and intervention groups. Overall, 5.2% of controls and 8.1% of the intervention group subsequently had mammograms, + 2.9%, OR 1.6 (p < .005). The findings were similar by urban/rural and AA/ non-AA subgroups. Rates and the effect were higher among the women age 70 ± 79: 6.5% of control and 10.6% of intervention, + 4.1%, OR 1.6 (p < .02). Projecting to the Medicare population in Michigan, a total cost of $117,000 to $278,000 for a state wide intervention would produce 3,700 to 5,000 mammograms at $32 to $54 per additional mammogram in this reticent group. CONCLUSION: This approach for measurement and intervention is feasible, effective, and can be directly implemented in other states and nationally. Targeting a reticent group of older women, this intervention demonstrated a significant improvement in subsequent mammography. This targeted approach is likely to be more cost effective than``blanket'' community-based approaches with significantly higher overall cost but the same target group of reticent older women. Future research can address variations to increase the communication's effectiveness (e.g., multiple communications). The approach to measurement and intervention can be tried for other preventive services in the Medicare or other defined populations. However, few data are available about how often patients do not know or misunderstand the reasons for their medications. We studied a group of general medicine outpatients to assess patient understanding of their medications. METHODS: Patients seen in four Boston general medicine practices from Sept 1999 to March 2000 (6 weeks per clinic) and who received at least one prescription from a study physician (6 MDs per clinic) were eligible for the study. Approximately two weeks after the index visit, patients were telephoned (response rate 59%) and asked to retrieve all of their pill bottles, read the name of each medication, and state their reason for taking it. Answers were coded``know'' or`d on't know,'' and the reasons were recorded verbatim. The accuracy of``know'' responses was coded by a physician-reviewer on a 5-point scale.