Breast and Cervical Screening by Race/Ethnicity

Abstract

Background Traditionally, economic recessions have resulted in decreased utilization of preventive health services. Purpose To explore racial and ethnic differences in breast and cervical cancer screening rates before and during the Great Recession. Methods The Medical Expenditure Panel was the source for identifying 10,894 women, ages 50–74 for breast screening and 19,957 women, ages 21–65 for cervical screening. Survey years included 2004-2005 and 2009-2010. Dependent variables were as follows: 1) receipt of mammogram within the past 2 years; and 2) receipt of a Pap smear within the past 3 years. The interaction of the recession and the likelihood of screening between whites and minorities was analyzed. Multivariate regressions were applied to estimate the likelihood of screening for the two time periods while controlling for a recession variable. Results Nationally, breast and cervical cancer screening rates dropped during the recession period; white women contributed most to the decline. However, there were significant improvements in timely screening for both cancers among Hispanics during the recession period. After controlling for the recession, African American women were more likely to have timely screenings compared to white women. Screening rates during the recession were lowest in the South, Midwest and West. Conclusion There was a national reduction in the percentages of women who obtained timely breast and cervical screenings during the Great Recession. Outreach efforts are needed to ensure that women who were not screened during the recession are screened. Widespread education about the Affordable Care Act may be helpful.

Trends in breast and colorectal cancer screening among U.S. adults by race, healthcare coverage, and SES before, during, and after the great recession

“…These results are consistent with other studies examining cancer screening trends in the U.S. A recent study observed that breast cancer screening decreased in the recession, a trend attributed to a decline in insurance coverage caused by the recession, predominantly among White women ( King et al, 2014 ). Contrary to our results, one study examining colorectal cancer screening, before and during the recession, observed that those with insurance reported significant declines in colonoscopy screening during the recession.…”

“…For instance, King et al observed that mammography screening was higher among Black participants in comparison to Whites before and during the recession. They postulated that this may be due to less severe income reductions for Blacks, and/or a higher percentage of Blacks qualifying for public insurance ( King et al, 2014 ). Alternatively, Akinyemiju et al reported that screening rates were actually higher for White participants compared Black participants after adjusting for misclassification in self-reported screening rates ( Akinyemiju et al, 2012 ).…”

Medicaid Expansion and Breast Cancer Screening in Appalachia and Non-Appalachia, United States, BRFSS 2003 to 2015

“…Previous studies have examined the impact of Medicaid expansion on self-reported breast cancer screening among US adults. 3,26,33-40 Similar to our findings, other studies have observed significant reductions in breast cancer screening in the post-expansion period. 26,34-36,39 Two US studies 26,36 found a 13% 26 and 20% 36 reduced odds of breast cancer screening in the post-expansion period among women aged 50 to 74 years.…”

“…Future studies are needed to better target these disparate populations and address barriers to health-care access. Fourth, while self-reported measures of women’s cancer screening in the BRFSS have been validated 47,48 as we and others have shown that 34-37,39 self-reported measures of breast cancer screening are subject to recall bias 49 resulting in misclassification, with a significant proportion of participants overreporting screening practices. Data using objective measures of screening from claims data across Medicaid expansion and Appalachia states may be necessary to definitively estimate the impact of the ACA on breast cancer screening in the United States.…”

“…A previous study also reported a 28% reduction in screening during 2009 to 2010 compared with 2004 to 2005 using the Medical Expenditure Panel Survey. 37 Two cross-sectional studies using the BRFSS found higher prevalence of self-reported mammography in the expanded states of 5% 33 and 3% 40 in 2012 and 2014, respectively, and a separate study observed that among low-income women, screening rates were 8% higher in expanded states compared to nonexpanded states. 40 Our study adds more recent, empirical data regarding the impact of Medicaid expansion on breast cancer screening in the United States and reveals that, in general, there were declines in breast cancer screening in the post-ACA period in both expanded and non-expanded states, regardless of Appalachia status.…”