Abstract
Objective
To describe the number and proportion of eligible women receiving mammograms funded by the National Breast and Cervical Cancer Early Detection Program (NBCCEDP).
Methods
Low-income, uninsured, and underinsured women aged 40–64 are eligible for mammography screening through the NBCCEDP. We used data from the NBCCEDP, the Current Population Survey, and Medical Expenditure Panel Survey to describe the number and proportion of women screened by the NBCCEDP and overall.
Results
In 2011 and 2012, the NBCCEDP screened 549,043 women aged 40–64, an estimated 10.6 % (90 % confidence interval [CI] 10.4–10.9 %) of the eligible population. We estimate that 30.6 % (90 % CI 26.4–34.8 %) of eligible women aged 40–64 were screened outside the NBCCEDP, and 58.8 % (90 % CI 54.6–63.0 %) were not screened. The proportion of eligible women screened by the NBCCEDP varied across states, with an estimated range of 3.2 % (90 % CI 2.9–3.5 %) to 52.8 % (90 % CI 36.1–69.6 %) and a median of 13.7 % (90 % CI 11.0–16.4 %). The estimated proportion of eligible women aged 40–64 who received mammograms through the NBCCEDP was relatively constant over time, 11.1 % (90 % CI 10.2–11.9 %) in 1998–1999 and 10.6 % (90 % CI 10.4–11.9 %) in 2011–2012 (p = 0.23), even as the number of women screened increased from 343,692 to 549,043.
Conclusions
Although the NBCCEDP provided screening services to over a half million low-income uninsured women for mammography, it served a small percentage of those eligible. The majority of low-income, uninsured women were not screened.
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References
Nelson HD, Tyne K, Naik A, Bougatsos C, Chan BK, Humphrey L (2009) Screening for breast cancer: an update for the US Preventive Services Task Force. Ann Intern Med 151:727–737
Sabatino SA, Coates RJ, Uhler RJ, Breen N, Tangka F, Shaw KM (2008) Disparities in mammography use among US women aged 40–64 years, by race, ethnicity, income, and health insurance status, 1993 and 2005. Med Care 46:692–700
Centers for Disease Control and Prevention (2012) Cancer screening—United States, 2010. MMWR 61:41–46
Finkelstein A, Taubman S, Wright B, Bernstein M, Gruber J, Newhouse JP, Allen H, Baicker K, Oregon Health Study Group (2012) The Oregon health insurance experiment: evidence from the first year. Quart J Econ 127:1057–1106
Trivedi AN, Rakowski W, Ayanian JZ (2008) Effect of cost sharing on screening mammography in medicare health plans. N Engl J Med 358:375–383
Lee NC, Wong FL, Jamison PM, Jones SF, Galaska L, Brady KT, Wethers B, Stokes‐Townsend GA (2014) Implementation of the National Breast and Cervical Cancer Early Detection Program: the beginning. Cancer 120(Suppl 16):2540–2548
Tangka FKL, Howard D, Royalty J, Danzell LP, O’Hara B, Miller J, Sabatino S, Joseph K, Guy G, Hall IJ (2014) Cervical cancer screening of underserved women in the United States: results from the National Breast and Cervical Cancer Early Detection Program, 1997–2012. Cancer Causes Control (this supplement)
Tangka FKL, Dalaker J, Chattopadhyay SK, Gardner JG, Royalty J, Hall IJ, DeGroff A, Blackman DK, Coates RJ (2006) Meeting the mammography screening needs of underserved women: the performance of the National Breast and Cervical Cancer Early Detection Program in 2002–2003. Cancer Causes Control 17:1145–1154
U.S. Department of Health and Human Services (2013) 2013 Poverty guidelines. http://aspe.hhs.gov/poverty/13poverty.cfm. Accessed 21 July 2014
DeNavas-Walt C, Proctor BD, Smith J (2013) Current Population Reports, P60–245. Income, poverty, and health insurance coverage in the United States: 2012. US Government Printing Office. http://www.census.gov/prod/2013pubs/p60-245.pdf. Accessed 21 July 2014
US Census Bureau (2013) Source and accuracy of estimates for income, poverty, and health insurance coverage in the United States: 2012. http://www.census.gov/hhes/www/p60_245sa.pdf. Accessed 21 July 2014
US Census Bureau (2006) Current Population Survey: design and methodology. Technical paper 66. http://www.census.gov/prod/2006pubs/tp-66.pdf. Accessed 21 July 2014
US Census Bureau. Modified race summary methodology. http://www.census.gov/popest/data/historical/files/MRSF-01-US1.pdf. Accessed 21 July 2014
Howard DH, Richardson LC, Thorpe KE (2009) Cancer screening and age in the United States and Europe. Health Aff 28:1838–1847
Machlin S, Yu W, Zodet M (2015) Computing standard errors for MEPS estimates. http://meps.ahrq.gov/survey_comp/standard_errors.jsp. Accessed 25 July 2015
National Center for Health Statistics (2014). Health, United States, 2013: with special feature on prescription drugs. http://www.cdc.gov/nchs/data/hus/hus13.pdf#083. Accessed 21 July 2014
Hoerger TJ, Ekwueme DU, Miller JW, Uzunangelov V, Hall IJ, Segel J, Royalty J, Gardner JG, Smith JL, Li C (2011) Estimated effects of the National Breast and Cervical Cancer Early Detection Program on breast cancer mortality. Am J Prev Med 40:397–404
DeNavas-Walt C, Proctor BD, Mills RJ (2004) US Census Bureau Current Population Reports, P60-226, Income, Poverty, and Health Insurance Coverage in the United States: 2003. US Government Printing Office, Washington, DC
Sharpe RE Jr, Levin DC, Parker L, Rao VM (2013) The effect of the controversial US Preventive Services Task Force recommendations on the use of screening mammography. J Am Coll Radiol 10:21–24
Wang AT, Fan J, Van Houten HK, Tilburt JC, Stout NK, Montori VM, Shah ND (2014) Impact of the 2009 US Preventive Services Task Force guidelines on screening mammography rates on women in their 40s. PLoS ONE 9:e91399
Howard DH, Adams EK (2012) Mammography rates after the 2009 US Preventive Services Task Force breast cancer screening recommendation. Prev Med 55:485–487
Pace LE, He Y, Keating NL (2013) Trends in mammography screening rates after publication of the 2009 US Preventive Services Task Force recommendations. Cancer 119:2518–2523
White A, Miller J, Royalty J, Ryerson BA, Benard V, Helsel W, Kammerer W (2015). Clinical outcomes of mammography in the National Breast and Cervical Cancer Early Detection Program, 2009–2012. Cancer Causes Control (this supplement)
Levy AR, Bruen BK, Ku L (2012) Health care reform and women’s insurance coverage for breast and cervical cancer screening. Prev Chronic Dis 9:E159
Congress of the United States, Congressional Budget Office (2014) Updated estimates of the effects of the insurance coverage provisions of the Affordable Care Act, April 2014. http://www.cbo.gov/sites/default/files/cbofiles/attachments/45231-ACA_Estimates.pdf. Accessed 15 May 2014
Kaiser Family Foundation (2014) The coverage gap: uninsured poor adults in states that do not expand Medicaid. http://kff.org/health-reform/issue-brief/the-coverage-gap-uninsured-poor-adults-in-states-that-donot-expand-medicaid/. Accessed 21 July 2014
Acknowledgments
Dr. Howard received support for this research from the Centers for Disease Control and Prevention (12IPA1203126).
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The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention or the US Census Bureau.
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Howard, D.H., Tangka, F.K.L., Royalty, J. et al. Breast cancer screening of underserved women in the USA: results from the National Breast and Cervical Cancer Early Detection Program, 1998–2012. Cancer Causes Control 26, 657–668 (2015). https://doi.org/10.1007/s10552-015-0553-0
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DOI: https://doi.org/10.1007/s10552-015-0553-0