Poor understanding of insurance benefits deters many women from breast screening

According to a new study, one of the most commonly reported barriers to breast cancer screening in the U.S., financial burden, may often be the result of misperception.

Researchers say because many women, especially older women with low incomes, misunderstand the insurance coverage of breast cancer and overestimate extra costs, they avoid having mammograms.

Breast cancer is one of the leading causes of cancer and cancer death among women in the U.S., but screening mammography remains underutilized, and studies show about one in four women over 40 have not had a mammogram within the last two years while almost 40 percent of low income women have never had a mammogram.

Cost has often been identified as a dominant factor and a barrier in women's screening decisions but until now few studies have investigated the relationship between actual coverage and women's perception of coverage – and actual cost.

Ann Scheck McAlearney, Sc.D. of Ohio State University in Columbus, and her research colleagues, in a secondary analysis of baseline data from a study designed to improve mammography screening, examined responses from 897 women who needed a mammogram. They wanted to confirm the cost barrier to screening and they did indeed find that a lack of accurate knowledge of coverage rather than actual costs deterred many women from screening.

In the study more than 50 percent of participating women identified cost as a screening barrier and of these, 40 percent misunderstood their insurance coverage of mammography, regardless of the type of insurance they had.

Those women who underestimated or had no knowledge of their insurance coverage were also significantly more likely to identify cost as a prohibitive factor in breast cancer screening.

Age and income also appeared to be factors predicting poor understanding of insurance coverage. Women 65 years and older and women earning less than $20,000 per year were found to be significantly more likely to misunderstand their insurance coverage of screening mammography.

The researchers say that screening utilization campaigns should not only push for greater insurance coverage, but also educate women about their own insurance coverage.

The authors conclude that "these results suggest that improving women's knowledge about the actual out-of-pocket costs and insurance coverage for screening mammograms may reduce the overall impact of cost as a barrier."

The study will appear in the June 15, 2005 issue of CANCER.