Confusion about cost may lower mammogram rates

Many women in the U.S. forego breast cancer screening because they think they can't afford the test, whereas their insurance provider would absorb much of the cost, new study findings suggest.

The cost of the screening test is often cited as a problem, but the greater problem may be one of understanding, said study author Dr. Ann Scheck McAlearney.

"We say that cost is a barrier...but to the extent that many women don't know what the cost is, maybe it's not as big a barrier," as it is often perceived to be, said McAlearney, of The Ohio State University in Columbus.

Mammograms are known to be key to the early detection of breast cancer, yet in 2002 nearly one in four women aged 40 years and older said they had not had a mammogram within the past two years, as is recommended. Nearly four out of every 10 low-income women said they had never had a mammogram, according to previously published research.

When asked why they had not had a Mammogram, a few women said they were lazy and some said they were embarrassed or fearful, but the most frequently cited reason was cost, the authors of the current report note in the journal Cancer.

Mammogram costs vary according to a patient's insurance coverage. Private insurance and Medicaid typically cover the full cost of the screening test while Medicare covers 80 percent, leaving women to pay about $30 in out-of-pocket costs.

Uninsured women may be able to reduce their expenses by participating in the Breast and Cervical cancer Control Program or other reduced-cost programs available in most states.

To investigate women's perceptions of insurance coverage for mammography, McAlearney and her colleagues analyzed interviews with 897 women aged 40 years and older. The women were interviewed between 1998 and 2002 as part of a North Carolina intervention to improve breast cancer screening rates in Robeson County.

More than half (53 percent) of the women said that the cost of mammograms barred them from undergoing the screening test, yet 40 percent of them were wrong about their exact level of insurance coverage, the researchers report.

"Indeed, women's understanding of their coverage - even when inaccurate or incomplete - appears to affect their perceptions of cost as a barrier," the researchers write.

In light of the findings, McAlearney would like doctors not only to advise women to get mammograms, but also to give them information about the cost of the screening tests.

"Providers need to help direct women to preventive services with, I think, a little bit more specific information about cost and coverage," she said. Women, on the other hand, also need to take responsibility for knowing their level of insurance coverage.