To evaluate and compare annual and biennial mammography screening rates across age, race, and geographic location (rural-urban) and to determine mammography screening persistence over 10 years among women enrolled in the West Virginia (WV) Medicaid Fee-for-Service (FFS) program.
Methods:
The WV Medicaid FFS administrative claims data for women recipients aged 40–64 from 1999 to 2008 were used for study purposes. Annual and biennial screening rates and persistence with screening were determined for women who were continuously enrolled in the WV Medicaid FFS program for respective calendar years.
Results:
A steady decline in the annual and biennial screening rates over a 10-year period (1999–2008) was observed among women recipients aged 40–64 years in the WV Medicaid FFS program, and screening persistence was also lower. Both annual and biennial screening rates and persistence varied by different demographic characteristics.
Conclusions:
Although mammography screening services are covered under Medicaid programs, underuse persists as a major concern. The results of this study emphasize the need to identify and address barriers to mammography screening in low-income rural populations.
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References
1.
American Cancer Society. Breast cancer overview, 2009. www.cancer.org/acs/groups/cid/documents/webcontent/003037-pdf.pdf. 2010 August 23.
2.
American Cancer Society. Breast cancer facts & figures 2009–2010. Atlanta: American Cancer Society, 2009.
3.
ChagparAB, McMastersKM. Trends in mammography and clinical breast examination: A population-based study. J Surg Res, 2007; 140:214–219.
4.
HansenNM, GrowneyA. Breast cancer: pre- and postoperative imaging for staging. Surg Oncol Clin north Am, 2007; 16:447–463.
5.
American Cancer Society. Breast cancer facts & figures 2007–2008. Atlanta: American Cancer Society, 2007.
6.
FletcherSW, ElmoreJG. Clinical practice. Mammographic screening for breast cancer. N Engl J Med, 2003; 348:1672–1680.
7.
NelsonHD, TyneK, NaikA, BougatsosB, ChanBK, HumphreyL. Screening for breast cancer: An update for the U.S. Preventive Services Task Force. AHRQ Publication No. 10-05142-EF-5, 2009. Agency for Healthcare Research and Quality: Rockville, MDwww.ahrq.gov/clinic/uspstf09/breastcancer/brcanup.htm. 2010 December 20.
8.
GarfinkelL, BoringCC, HeathCWJr.Changing trends. An overview of breast cancer incidence and mortality. Cancer, 1994; 74,Suppl 1:222–227.
9.
BarthRJJr, GibsonGR, CarneyPA, MottLA, BecherRD, PoplackSP. Detection of breast cancer on screening mammography allows patients to be treated with less-toxic therapy. Am J Roentgenol, 2005; 184:324–329.
10.
FeigSA, D'OrsiCJ, HendrickREet al.American College of Radiology guidelines for breast cancer screening. Am J Roentgenol, 1998; 171:29–33.
11.
HumphreyLL, HelfandM, ChanBK, WoolfSH. Breast cancer screening: A summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med, 2002; 137:347–360.
TabarL, YenMF, VitakB, ChenHH, SmithRA, DuffySW. Mammography service screening and mortality in breast cancer patients: 20-year follow-up before and after introduction of screening. Lancet, 2003; 361:1405–1410.
14.
GøtzschePC, NielsenM. Screening for breast cancer with mammography. Cochrane Database Syst Rev, 2009; 4:CD001877.
15.
SmithRA, CokkinidesV, BrawleyOW. Cancer screening in the United States, 2009: A review of current American Cancer Society guidelines and issues in cancer screening. CA Cancer J Clin, 2009; 59:27–41.
16.
National Cancer Institute. Breast cancer (PDQ): Mammograms. U.S. National Institutes of Health. www.cancer.gov/cancertopics/factsheet/Detection/mammograms. 2009 December 27.
17.
National Institutes of Health Consensus Development Panel. National Institutes of Health Consensus Development Conference Statement: Breast cancer screening for women ages 40–49, January 21–23, 1997. J Natl Cancer Inst, 1997; 89:1015–1026.
18.
QaseemA, SnowV, SherifK, AronsonM, WeissKB, OwensDK. Screening mammography in women 40 to 49 years of age: A clinical practice guideline from the American College of Physicians. Ann Intern Med, 2007; 146:511–515.
19.
BrewerNT, ReiterPL. Assessing and increasing breast cancer screening. Prev Med, 2008; 47:483–484.
20.
Centers for Disease Control and Prevention, 2009. Breast and Cervical Cancer Prevention and Treatment Act of 2000. www.cdc.gov/cancer/nbccedp/legislation/law106-354.htm. 2010 July 7.
21.
U.S. Department of Health and Human Services. Healthy people 2010. Volume II: Objectives for improving health (Part B)2nd. Washington, DC: U.S. Government Printing Office, 2000.
22.
BlackmanDK, BennettEM, MillerDS. Trends in self reported use of mammograms (1989–1997) and Papanicolaou tests (1991–1997)—Behavioral Risk Factor Surveillance System. MMWR CDC Surveillance Communication, 1999; 48:1–22.
23.
SwanJ, BreenN, CoatesRJ, RimerBK, LeeNC. Progress in cancer screening practices in the United States: Results from the 2000 National Health Interview Survey. Cancer, 2003; 97:1528–1540.
24.
BreenN, CroninK, MeissnerHI. Reported drop in mammography: Is this cause for concern?Cancer, 2007; 109:2405–2409.
25.
DavisTC, ArnoldC, BerkelHJ, NandyI, JacksonRH, GlassJ. Knowledge and attitude on screening mammography among low-literate, low-income women. Cancer, 1996; 78:1912–1920.
26.
Centers for Disease Control and Prevention. Use of mammography services by women aged >or =65 years in Medicare—United States, 1991–1993. MMWR, 1995; 44:777–781.
27.
PearlmanDN, RakowskiW, EhlrichB, ClarkMA. Breast cancer screening practices among black, Hispanic, and white women: Reassessing differences. Am J Prev Med, 1996; 12:327–337.
28.
HalpernMT, BianJ, WardEM, SchragNM, ChenAY. Insurance status and stage of cancer at diagnosis among women with breast cancer. Cancer, 2007; 110:403–411.
29.
HallidayT, TairaDA, DavisJ, ChanH. Socioeconomic disparities in breast cancer screening in Hawaii. Prev Chronic Dis, 2007; 4:A91.
30.
IvesDG, LaveJR, TravenND, SchulzR, KullerLH. Mammography and Pap smear test use among older rural women. Public Health Rep, 1996; 111:244–250.
31.
RimerBK, TrockB, EngstromPF, LermanC, KingE. Why do some women get regular mammograms?Am J Prev Med, 1991; 7:69–74.
32.
BjurstamN, BjörneldL, DuffySWet al.The Gothenburg Breast Cancer Screening Trial: Preliminary results on breast cancer mortality for women aged 39–49. J Natl Cancer Inst Monogr, 1997; 22:53–55.
33.
ChuKC, SmartCR, TaroneRE. Analysis of breast cancer mortality and stage distribution by age for the Health Insurance Plan clinical trial. J Natl Cancer Inst, 1988; 80:1125–1132.
34.
AdamsEK, BreenN, JoskiPJ. Impact of the National Breast and Cervical Cancer Early Detection Program on mammography and Pap test utilization among white, Hispanic, and African American women: 1996–2000. Cancer, 2007; 109,Suppl 2:348–358.
35.
KhannaR, BhanegaonkarA, ColsherP, MadhavanSS, HalversonJ. Breast cancer screening, incidence, and mortality in West Virginia. WV Med J, 2009; 105:24–32.
36.
McAlearneyAS, ReevesKW, TatumC, PaskettED. Perceptions of insurance coverage for screening mammography among women in need of screening. Cancer, 2005; 103:2473–2480.
37.
LyttleNL, StadelmanK. Assessing awareness and knowledge of breast and cervical cancer among Appalachian women. Prev Chronic Dis, 2006; 3:A125.
38.
CoughlinSS, ThompsonTD, HallHI, LoganP, UhlerRJ. Breast and cervical carcinoma screening practices among women in rural and nonrural areas of the United States, 1998–1999. Cancer, 2002; 94:2801–2812.
39.
MobleyLR, KuoTM, ClaytonLJ, EvansWD. Mammography facilities are accessible, so why is utilization so low?Cancer Causes Control, 2009; 20:1017–1028.
40.
SchuelerKM, ChuPW, Smith-BindmanR. Factors associated with mammography utilization: A systematic quantitative review of the literature. J Womens Health, 2008; 17:1477–1498.
41.
O'MalleyAS, ForrestCB, MandelblattJ. Adherence of low-income women to cancer screening recommendations. J Gen Intern Med, 2002; 17:144–154.
42.
GierischJM, O'NeillSC, RimerBK, DeFrankJT, BowlingJM, SkinnerCS. Factors associated with annual-interval mammography for women in their 40s. Cancer Epidemiol, 2009; 33:72–78.
43.
PeekME, HanJH. Disparities in screening mammography. Current status, interventions and implications. J Gen Intern Med, 2004; 19:184–194.
44.
BorrayoEA, JenkinsSR. Feeling frugal: Socioeconomic status, acculturation, and cultural health beliefs among women of Mexican descent. Cultur Divers Ethnic Minor Psychol, 2003; 9:197–206.
45.
FiscellaK, FranksP, DoescherMP, SaverBG. Disparities in health care by race, ethnicity, and language among the insured. Med Care, 2002; 40:52–59.
46.
DeVoeJE, FryerGE, PhillipsR, GreenL. Receipt of preventive care among adults: Insurance status and usual source of care. Am J Public Health, 2003; 93:786–791.
47.
HedegaardHB, DavidsonAJ, WrightRA. Factors associated with screening mammography in low-income women. Am J Prev Med, 1996; 12:51–56.
48.
SabatinoSA, CoatesRJ, UhlerRJ, BreenN, TangkaF, ShawKM. Disparities in mammography use among US women aged 40–64 years, by race,ethnicity, income, and health insurance status, 1993 and 2005. Med Care, 2008; 46:692–700.
49.
RoetzheimRG, PalN, TennantCet al.Effects of health insurance and race on early detection of cancer. J Natl Cancer Inst, 1999; 91:1409–1415.
50.
DuBardCA, SchmidD, YowA, RogersAB, LawrenceWW. Recommendation for and receipt of cancer screenings among Medicaid recipients 50 years and older. Arch Intern Med, 2008; 168:2014–2021.
51.
RileyG, PotoskyA, LubitzJ, BrownM. Stage of cancer at diagnosis for Medicare HMO and fee-for-service enrollees. Am J Public Health, 1994; 84:1598–1604.
52.
United States Department of Agriculture (USDA), Economic Research Service (ERS). Measuring rurality: Rural-urban continuum codes. 2004. www.ers.usda.gov/Briefing/Rurality/RuralUrbCon/. 2009 December 20.
53.
American Cancer Society. Cancer facts & figures 2008. Atlanta: American Cancer Society, 2008. www.cancer.org/acs/groups/content/@nho/documents/document/2008cafffinalsecuredpdf.pdf. 2010 August 23.
54.
GlassAG, LaceyJVJr, CarreonJD, HooverRN. Breast cancer incidence, 1980–2006: Combined roles of menopausal hormone therapy, screening mammography, and estrogen receptor status. J Natl Cancer Inst, 2007; 99:1152–1161.
55.
KatalinicA, RawalR. Decline in breast cancer incidence after decrease in utilisation of hormone replacement therapy. Breast Cancer Res Treat, 2008; 107:427–430.
56.
RyersonAB, MillerJW, EhemanCR, LeadbetterS, WhiteMC. Recent trends in U.S. mammography use from 2000–2006: A population-based analysis. Prev Med, 2008; 47:477–482.
57.
WelshAL, SauaiaA, JacobellisJ, MinSJ, ByersT. The effect of two church-based interventions on breast cancer screening rates among Medicaid-insured Latinas. Prev Chronic Dis, 2005; 2:A07.
58.
KreherNE, HicknerJM, RuffinMT4th, LinCS. Effect of distance and travel time on rural women's compliance with screening mammography: An UPRNet study. Upper Peninsula Research Network. J Fam Pract, 1995; 40:143–147.
59.
Breast Screening Frequency Trial Group (BSFTG). The frequency of breast cancer screening: Results from the UKCCCR randomized trial. United Kingdom Coordinating Committee on Cancer Research. Eur J Cancer, 2002; 38:1458–1464.
60.
TangTS, PattersonSK, RoubidouxMA, DuanL. Women's mammography experience and its impact on screening adherence. Psychooncology, 2009; 18:727–734.
61.
BreenN, WagenerDK, BrownML, DavisWW, Ballard-BarbashR. Progress in cancer screening over a decade: Results of cancer screening from the 1987, 1992, and 1998 National Health Interview Surveys. J Natl Cancer Inst, 2001; 93:1704–1713.
62.
ClarkMA, RakowskiW, BonacoreLB. Repeat mammography: Prevalence estimates and considerations for assessment. Ann Behav Med, 2003; 26:201–211.
63.
FreemanJL, KlabundeCN, SchusslerN, WarrenJL, VirnigBA, CooperGS. Measuring breast, colorectal, and prostate cancer screening with Medicare claims data. Med Care, 2002; 40,Suppl 8:IV-36–42.
64.
West Virginia Department of Health and Human Resources. The West Virginia 2010 Objectives. www.wvdhhr.com/bph/hp2010/objective/3.htm. 2009 December 12.
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