Price of Survival: Mammogram Costs Deter Many


Arlene Brown learned exactly how expensive a mammogram can be in 2002.

Her health insurance was retroactively canceled due to the cost of her husband's hospitalization. Suddenly, what would have otherwise been a free test cost her hundreds of dollars.

"About three months after our health insurance was canceled, I called to make my yearly mammography appointment and realized that the screening would cost about $400," Brown explained.

Because Brown had a higher breast cancer risk than most other women, she required a more expensive, computer-assisted type of mammogram. Unable to pay such a high price, however, she deferred the screening test and began going in for her mammogram only as often as she could afford to -- about once every 18 months.

The story is an all too-common one, according to new research released Wednesday. But Brown is far from a stereotype when it comes to women who skip their mammograms because of out-of-pocket costs.

Brown is a family practice physician at Lincoln County Medical Center in Ruidoso, N.M.

"I think I have a relatively good understanding of the kinds of financial issues faced by a lot of patients because I go through them too," she said.

The American Cancer Society recommends that women over 40 receive a mammogram once every year. But a new study finds that, like Brown, many women skip their mammogram each year due to high out-of-pocket costs for the screening.

Researchers at Brown University in Providence, R.I., looked at 366,475 women covered by 174 different Medicare managed-care plans and found that even costs less than those Brown faced present a hurdle for many women.

They reported that those who have co-payments of more than $10 are less likely to get regular mammograms than those with more generous insurance coverage.

Mammogram screening rates were about 8 percent lower among women who had to pay more than $10 or 10 percent of a mammogram's cost, researchers found.

Researchers then examined health plans that once fully covered the costs of mammograms but later switched to only partial coverage.

From 2002 to 2004, mammography rates decreased by 5.5 percent in seven of these plans. However, in 14 other plans that continued to offer full coverage of mammograms, screening rates for breast cancer increased by 3.4 percent.

And the number of plans requiring women to make higher co-payments are on the rise. In 2004, one out of nine women was forced to pay for at least 10 percent of the cost of a mammogram out-of-pocket.

The worst impacts were seen among minorities and patients from communities with lower income and education levels, as these patients were mostly likely to enroll in cheaper health insurance plans that require co-payments for mammography.

Dr. Amal Trivedi, lead study investigator and assistant professor of community health at Brown, said that all health insurance plans should offer full coverage for mammography so that the greater good is served -- in this case, higher levels of mammography screening and fewer deaths from breast cancer.

"It's important for women to understand that mammograms are a very valuable preventive health service, and there's a lot of data that shows that women who get mammogram screenings are diagnosed at earlier stage of breast cancer and are therefore less likely to die from breast cancer," Trivedi explained.

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