Posted on Dec 14, 2010 by Sergio Ulloa
Breast cancer is the most common form of cancer among women, accounting for around 16 percent of all female cancers. It kills around 519,000 women every year, worldwide.
A recent US study
, conducted by the Medco Research Institute, reveals that only half of insured women aged over 40 are claiming annual mammogram screenings, despite recommendations endorsed across the US and the world.
The Medco Research Institute
is an evidence based clinical research organization that branch from the US privately owned pharmacy manager, Medco Health Solutions.
Health organizations worldwide, such as the US National Cancer Institute
, agree that women aged 40 years and older should have screening mammograms every 1 to 2 years. The US National Cancer Institute states that age is the most important risk factor for breast cancer among women. Women aged 50 years or older will typically have the highest rates of breast cancer within a population.
The Medco Research Institute aimed to identify the prevalence of annual mammograms among women aged 40 years and over. This was achieved by calculating the number of annual mammogram claims between 2006 to 2009 among insured women. Data was collected using administrative records retrieved from Medco's integrated database.
More than 1.5 million women qualified for the study. The target population were of females, aged 40 years and over with continuous insurance coverage between 2006 and 2009. Women with a previous history of breast cancer were excluded from the study, including those who had either a mastectomy, chemotherapy or radiotherapy.
Results indicated a low compliance of mammogram screening across the study group. Only a small group of women in the study achieved the recommended annual mammogram screening at 16 percent among the 40 to 49 age group, and 23 percent among the 50 to 64 age group. It was shown that approximately 50 percent of women aged over 40 received annual mammograms over the four year study. However, only 40 percent of women aged over 50 years received the recommended minimum of 2 mammograms during the study period. 78 percent of the entire study group received at least one mammogram over the four years.
The term mammogram screening refers to the routine check up among women, who are symptom free, for early detection of breast cancer. A breast cancer tumor, in its early stages, is likely to be small and confined to the breast, and undetectable by self examination. A mammogram is an X-ray picture of the breast that is able to pick up abnormal breast tissue including tiny mineral deposits of calcification, or a mass, which may be a tumor or a cyst. Any abnormal findings are referred for further investigations to determine whether they are cancerous. The size of the breast cancer tumor and how far it has spread are among the important factors used to predict the patient's prognosis. Mammogram screening has therefore been regarded as a highly important early detection tool so that treatment can be started early, possibly before it has progressed and spread to other areas.
The cost for a mammogram screening varies from facility to facility, however the cost is typically between US$80 and $150, but can also be priced over US$200 at certain medical institutions. Women in the US who are eligible for Medicare coverage are entitled to an annual mammogram screening when they reach 40 years of age. Both the UK and Australian Governments offer free mammogram screening programs through the NHS Breast Cancer Screening Plan
and BreastScreen Australia
. UK women aged 50 years and over are offered a scan every three years, whereas Australian women aged 40 years and over are offered a scan every two years. The cost of mammogram screening in the UK is around GBP$45 or US$71, lower in comparison to US costs.
As part of Obama's Health Reform
, disease prevention is promoted through the Affordable Care Act, by improving access to clinical preventive services including mammogram screening. From 2014, all US citizens will be required to have private health insurance or otherwise pay an annual fine. Under the Affordable Care Act, insurance plans beginning on or after 23rd September 2010, must cover a range of preventative services, with no cost sharing by the patient. Prior to this law, insurance companies were able to share the costs and some patients were paying a gap fee between US$10 and $35.
Given the implementation of the US Health Reform, a larger number of women will be taking out health insurance from 2014 and will therefore have access to free annual mammogram screening services. Whether there will be a low compliance of mammogram screening among newly-insured women is yet to be determined. However, it is probable that newly-insured individuals will be seeking primary care services more than ever before, given the cost of healthcare was a major barrier prior to the reform.
Mammogram screening programs are a topic of recent debate in the media. A recent study
, published in the New England Journal of Medicine, compares the rate of death from breast cancer among two groups; one who had mammogram screening and one without. Women aged between 50 and 69, living in Norway, were analysed over a period of ten years from 1996 to 2005. Data gained from the 40,000 women who had developed breast cancer, concluded that routine mammograms cut the breast cancer death rate by only 10 percent. An interview with the Norwegian researchers revealed that they were expecting at least a 30 percent reduction.
The US National Cancer Institute also lists the possible harms of mammogram screening, found through a meta-analysis
of individual data from seven randomized controlled trials. The US National Cancer Institute revealed mammogram screening may lead to treatment of insignificant cancers resulting in over diagnosis. Mammograms can also be misleading due to false-positive and false-negative testing. Furthermore, the risk of radiation-induced mutations resulting in breast cancer are increased, especially among the younger population. However, it is important to note that the US National Cancer Institute concluded that mammogram screening is beneficial to women, resulting in decreased morbidity relating to early detection of breast cancer.
Although the Medco Research Institute revealed some interesting figures in it's study, many questions are left unanswered. The study was restrictive in its findings, using quantitative methods there is little we can conclude without investigating the participant's reasoning and attitudes towards the compliance of mammogram screening. It is possible that the study will be used as a pilot in preparation for an in depth case study; however, at this stage there is no indication of a further investigation. Reasons why women decide against mammogram screening are suggested in various media sources and can vary from discomfort during the screening exam, controversial debate as to whether mammogram screening is valuable, access to facilities, or breast screening awareness.
Further research needs to be conducted in order to find out the specific reasons as to why there is a low compliance of mammogram screening among insured women in the US. It remains to be seen whether this number will increase given the addition of newly-insured women that we expect to see in 2014, following implementation of the US Reform that will make health insurance compulsory. With new insurance laws, health preventative measures are becoming more accessible to the public, whether or not the public complies is another issue.