Self-Reported Mammography Screening Among Oklahoma Women Age 50 and Older: Oklahoma Behavioral Risk factor Surveillance System

GR 3-2

12/02

Abstract

Screening Mammography for Oklahoma Medicare Beneficiaries: A National Priority for Quality Improvement.

Prepared by: Jan Park, Ph.D.

Gerontology Specialist

104 HES, Room 239

OCES, Oklahoma State University

Stillwater, OK 74078

405-744-6231

janpark@okstate.edu

Venkatappa, S.; Oehlert, W. H.; Nguyen, L.; Austelle, A.; and Bratzler, D. W.(2002, October). Screening Mammography for Oklahoma Medicare Beneficiaries: A National Priority for Quality Improvement. Journal Oklahoma State Medical Association, 655-660.

IMPLICATION FOR COOPERATIVE EXTENSION. Breast cancer is the most common disease in U. S. women. In 2002, approximately 203,500 women will be diagnosed with breast cancer and 39,600 will die of the disease. In Oklahoma, breast cancer is the second leading cause of death resulting in approximately 500 deaths per year. It is estimated that in 2003, 2700 new cases of breast cancer will be diagnosed in Oklahoma women. Mammography screening, early detection, and treatment lead to decreased mortality and longer survival. To aid in the early detection, mammography screening every one or two years for all women age 50 and older is strongly recommended by the National Cancer Institute, and the American Cancer Society.

The good news is that mammography screening in the U.S. and in Oklahoma has increased dramatically over the last decade. The passage of the Balanced Budget Act of 1997 provided that Medicare cover annual screening mammography for women aged 40 years and over who are covered by Medicare Part B. Additionally, the Medicare deductible is waived and beneficiaries only pay a 20 % co-payment. Yet, despite the availability of low cost mammography, only 76.2 % of U.S. women over age 40 were screened in 2000. Mammography screening of Oklahoma women fell below the national average when in 1991 only 54.5% were screened and in 2000 only 70.4 percent. Oklahoma ranks 47 in the nation in the utilization of screening mammography.

Medicare beneficiaries are in an age group considered at high risk for breast cancer. Beneficiaries are eligible for low cost mammography screening annually. The Centers for Medicare/Medicaid Services has identified improved utilization of mammography screening a national priority and implemented the Health Care Quality Improvement Program.

Mammography rates were analyzed for 217,829 Oklahoma women enrolled in the Medicare fee-for-service program. Mammography rates were highest for women aged 50-67 years and for Caucasians. Mammography rates were lowest for Asian and Native American women. The study also found utilization rates varied by geographic location. Of women aged 50-67 years, Woodward County has the highest rate at 67.9 % while Tillman County has the lowest rate at 37.4 %. Availability of certified mammography centers ranged from none in 30 counties to 26 in Oklahoma County.

While there is controversy as to the over all benefit of screening mammography, the American Cancer Society and the National Cancer Institute reaffirm

their recommendations in favor of screening mammography at least once every two years and preferably annually for women over the age of 40. Evidence is mounting that indicates mammography screening leads to increased early diagnosis. Likewise, there is sufficient scientific evidence that early diagnosis leads to improved clinical outcomes. The 5 year survival rates for women diagnosed with local breast cancers is 96% compared to 20% in women whose cancers have metastasized.

The screening mammography is a non-invasive test that is easily accessible, acceptable, and low cost. So why don’t U.S. women get screened? Studies indicate reasons include, lack of knowledge about the importance of annual mammograms; physicians not referring patients for mammography;

fear of learning that one has cancer; anxiety about screening methods; language barriers; low literacy skills and low educational level; cultural beliefs or values that do not encourage preventive health care, and cost. An additional barrier in Oklahoma is lack of permanent accessible screening centers. 30 counties have no certified mammography centers. Government and private mobile mammography units tour various parts of the state to partially make up for the absence of permanent centers.

Quality Improvement Organizations in each state have been implemented to improve screening mammography rates. The two most common interventions have been mailing educational materials directly to Medicare beneficiaries and supplying health care providers with mammography rates and lists of their patients who have not been screened.