Big Bias In Who Gets Screened for Breast Cancer

Certain women may miss out on routine tests that screen for early signs of breast cancer.

Elderly women, women with publicly funded health insurance and women who don't go to an obstetrician and gynecologist for routine exams are all less likely than others to get a clinical breast exam and a recommendation for a mammogram.

"A physician's recommendation is why many women undergo screening in the first place," said Rajesh Balkrishnan, the Merrell Dow professor of pharmacy at Ohio State University. "Foregoing these exams can increase a woman's risk of developing an advanced stage of breast cancer. There are several reasons why a physician may not give a patient a clinical breast exam or recommend a mammogram."

Balkrishnan led a study that uncovered some of these possible reasons. The findings currently appear online at the website of the journal Breast Cancer Research and Treatment.

The researchers gathered data from the National Ambulatory Medical Care Survey (NAMCS), a database run by the Centers for Disease Control and Prevention. The NAMCS contains information on a nationally representative sample of practicing physicians and patient visits throughout the United States. The researchers restricted their data set to physician office visits by women 40 and older from 1996 through 2004.

During that time, these women made an estimated 2.5 billion office visits, and physicians performed some 198 million clinical breast exams and made 110 million recommendations for mammograms. During a clinical breast exam, a physician feels the breast and surrounding tissue for any irregularities.

The researchers created a number of categories in order to determine which women were more likely to receive a clinical breast exam or a recommendation for a mammogram. The categories included patient age, a history of breast surgery or breast cancer diagnosis, type of insurance coverage and physician specialty.

The researchers found that women who see an ob-gyn for routine check ups were 18 times more likely to receive a clinical breast exam than if they visited any other kind of physician, including internists or family physicians. Ob-gyns were also 13 times more likely to recommend that their patients schedule a mammogram.

The type of insurance coverage a woman had was also a decisive factor. Compared to women with private health insurance, women with public health insurance (such as Medicaid and Medicare) were up to 30 percent less likely to receive a clinical breast exam. Doctors were up to 55 percent less likely to recommend that these women schedule a mammogram.

"Almost every medical association in the country recommends that a woman 45 and older get screened annually or at least every two years," Balkrishnan said. "Medicare and Medicaid pay for at least a portion of the cost of both exams for covered individuals. But patients and physicians may not be aware of this."