Poor Understanding of Coverage Deters Breast Cancer Screening

One of the most commonly reported barriers to breast cancer screening—financial burden—may often be the result of misperception, according to a new study appearing in the journal Cancer.

Researchers say a misunderstanding of insurance coverage of breast cancer screening may cause many women, especially older women with low incomes, to overestimate out-of-pocket costs, and avoid getting mammograms. The study concludes screening utilization campaigns should not only push for greater insurance coverage, but also educate women about their own insurance coverage.

While breast cancer is one of the leading causes of cancer and cancer death among women in the U.S., screening mammography remains underutilized, particularly by women from low-income families. Studies show about one in four women 40 and older have not had a mammogram within the last two years. Nearly 40 percent of low income women have never had a mammogram.

Barriers to screening have been often studied, with cost identified as a dominant factor in women’s screening decision. However, few studies have investigated the relationship between actual coverage and women’s perception of coverage—and therefore, cost. In a secondary analysis of baseline data from a study designed to improve mammography screening, Ann Scheck McAlearney, Sc.D. of Ohio State University in Columbus, and her research colleagues examined responses from 897 women who needed a mammogram to further characterize the cost barrier to screening.

They found that a lack of accurate knowledge of coverage rather than actual costs deterred many women from screening. More than 50 percent of participating women identified cost as a screening barrier. Of these, 40 percent misunderstood their insurance coverage of mammography, regardless of the type of insurance they had. Those women who underestimated or had no knowledge of their insurance coverage were also significantly more likely to identify cost as a prohibitive factor in breast cancer screening.

Furthermore, age and income were factors predicting poor understanding of insurance coverage. Women 65 years and older and women earning less than $20,000 per year were significantly more likely to misunderstand their insurance coverage of screening mammography.

The authors conclude that “these results suggest that improving women’s knowledge about the actual out-of-pocket costs and insurance coverage for screening mammograms may reduce the overall impact of cost as a barrier.”

SOURCE:
Cancer, June 15, 2005, published online May 9, 2005

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