Early screening through periodic mammography offers one of the most effective weapons against beast cancer mortality, but compliance with both one time and repeat screening is problematic. The purpose of this proposal is to identify and compare the independent and additive effects of tailored physician recommendation letters and tailored telephone counseling on 1) mammography compliance; 2) cognitive progression toward mammography; and to 3) estimate and compare the cost and cost-effectiveness of each intervention and their combination. Both tailored letters and tailored telephone counseling have shown promise for encouraging mammography screening, but neither their relative and additive effectiveness nor their cost-effectiveness is known. Subjects will include 1200 noncompliant women 51 and older from two states where mammography utilization is especially low, Indiana and Missouri. Interventions will be tailored according to individual's specific baseline responses regarding perceived susceptibility, perceived benefits and barriers associated with mammography, and stage of considering mammography. Behavioral outcomes will be measured dichotomously by whether subjects have had mammograms or by cognitive stage via Prochaska and DiClemente's cognitive stage model. Traditional cost and marginal cost-effectiveness analyses are planned. Conclusions will add to the knowledge bases needed to increase mammography screening in a cost-effective manner.