Patients concerned with medical expenses are less likely to undergo routine screening mammography exams, according to a new survey completed by more than 7,000 women.
Almost half of the 7,511 (aged 40 to 74) survey respondents admitted to anxiety pertaining to their ability to pay medical bills. Although routine screenings for breast cancer are covered by public and private insurance companies in most instances, patients may still be hesitant to complete their yearly mammograms.
Randy C. Miles, MD, MPH, Chief of Breast Imaging and Associate Director of Service for Radiology for Research at Denver Health, and colleagues discuss the possible thought process behind the decision to forego annual screening in a new paper in the Journal of the American College of Radiology:
Although the Affordable Care Act requires public and private health insurance companies to cover screening mammography with no copays or deductibles to improve access, fear of downstream costs related to a potential cancer diagnosis or patient misinterpretation of coverage parameters may result in nonengagement with routine screening.”
While nearly 70% of survey respondents reported completing a mammogram within the last two years, just over half—52.2%—reported receiving a mammogram within the last 12 months. Women who acknowledged worrying about their ability to pay medical bills were found to be less likely to complete breast cancer screening. These women were also more likely to skip medication doses and delay refilling prescriptions.
Of note, women who skipped screening due to financial concerns outnumbered those who were not screened due to logistical issues such as scheduling and transportation conflicts.
Financial Toxicity
The researchers credited fault to growing “financial toxicity”—a term they used to describe the “physical, psychological and financial burden associated with the cost of diagnostic services and treatment in oncology practice.”
The results of the study “support a growing body of literature that financial toxicity, whether direct or indirect, may negatively influence this early stage along the breast cancer care continuum,” the authors wrote.
It isn’t just women without insurance who fall victim to financial toxicity (though they are more likely to face financial barriers), the experts explained. Up to 25% of women between the ages of 50 and 64 have reported some form of out-of-pocket expense associated with their initial imaging, with those costs increasing for additional imaging and procedures after routine screening.
Greater efforts to engage with at-risk women are needed to address this issue, they suggested:
To improve screening mammography utilization among patients at risk for financial toxicity, healthcare organizations should consider administering screening questionnaires to identify women who may experience difficulties paying for diagnostic services as a part of their breast health intake forms. This information can be used to target women due for screening mammography, who may benefit from additional hospital resources.”
For more insight from the survey, visit the Journal of the American College of Radiology.
In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She joined Innovate Healthcare in 2021 and has since put her unique expertise to use in her editorial role with Health Imaging.