Misunderstandings real cost barrier to mammography

May 9 2005

Women often cite cost as one reason they don't get regular mammography check-ups, but a new study finds they often misunderstand or simply aren't aware of benefits in their insurance plans that might help offset any financial burden.

The study authors concluded that mammography screening campaigns may want to include information about insurance and health plan benefits to help reduce what appears to be a major barrier to the exams for some women.

The findings appear online today and will be published in the June 15 issue of the journal Cancer.

Studies show that regular mammography screenings can help detect breast cancer in its earliest stages, when it is most curable. Although the American Cancer Society recommends all women age 40 and over get screened annually, mammography remains underutilized, especially among poor and minority women. Studies show that nationwide, roughly 25 percent of the women who should be getting mammography have not had an exam in the past two years, and nearly 40 percent of poor women have never had a mammogram.

Ann McAlearney, an assistant professor in the Division of Health Services Management & Policy in The Ohio State University School of Public Health, examined data from a study of mammography screening rates among rural, poor and minority women in Robeson County , N. C. (the ROSE Project). That project, which began in 1998 under the direction of Electra Paskett, a professor of epidemiology and biostatistics in the School of Public Health, was created to test a health intervention strategy designed to improve mammography screening rates in that region.

The data included information from face-to-face interviews with 897 women age 40 or older. Researchers conducted the interviews to find out the women's attitudes toward mammography and to find whether they had the exams. The interviews included questions about the cost of mammography and details about the women's insurance coverage. Researchers later compared what the women believed about their insurance coverage with what their policies actually covered.

Over half of the respondents (53 percent) said they felt cost was a barrier to getting screened. Among this group, 40 percent did not fully understand or were not aware of benefits in their insurance plans that could help defray the cost of the procedure. The researchers found that women age 65 and over and those with the lowest incomes were more likely than others to misperceive their benefits.

The cost of mammography screening is highly variable in the United States , but a recent study at The Ohio State University Arthur G. James Cancer Hospital and Richard J. Solove Research Institute found the national average for an exam to be just under $125. In contrast, the actual cost of mammography screening in 1998 in Robeson County was about $60 at a radiology clinic accessible to many women in the study.

Interestingly, researchers discovered that women enrolled in government-provided insurance programs (Medicaid or Medicare) were generally better informed about their coverage compared to women enrolled in private insurance plans.

“This suggests a significant role for private insurers,” says McAlearney. “We feel private insurers could be very helpful in reducing the perception of cost as a barrier if they would step up their educational efforts and help these women to become more familiar with details of their policies.”

Though the authors say it would be inappropriate to conclude from this study alone that an educational campaign would help increase mammography screening rates, they note that the evidence suggests education would be helpful in correcting misperceptions about real, out-of-pocket expenses the exam requires.

Breast cancer is the second leading cause of cancer deaths among all women, but it can be especially devastating among some minority populations, and later detection means a lesser chance that treatments will be effective.

“We know that even though African-American women are less likely than white women to get breast cancer, they die of it more frequently,” says Paskett, who is associate director for population sciences at The Ohio State University Comprehensive Cancer Center. “Anything we can do to help increase early detection would be helpful.”

The National Cancer Institute supported the study.

Co-authors include Katherine Reeves and Cathy Tatum from the Center for Population Health and Health Disparities in the Division of Population Sciences in the Ohio State University Comprehensive Cancer Center .