Enhancing screening and early detection among women transitioning to Medicare from the NBCCEDP in Georgia

Abstract

Purpose The National Breast and Cervical Cancer Early Detection Program through each state's administration serves millions of low-income and uninsured women aged 40–64. Our purpose was to assess whether cases screened through Georgia's Breast and Cervical Cancer Program (BCCP) were diagnosed at an earlier stage of disease and whether those who used the state's program regularly continued to obtain age-appropriate screens as they aged out of BCCP into Medicare between 2000 and 2005. Methods We used BCCP screening data to identify women with more than one screen and an interval of 18 months or less between screens as “regular” users of BCCP. Using the linked BCCP and Medicare enrollment/claims data, we tested whether women with any BCCP use (n = 3,134) or “regular” users (n = 1,590) were more likely than women not using BCCP (n = 10,086) to exhibit regular screening under Medicare. We used linked BCCP and Georgia Cancer Registry data to examine breast cancer incidence and stage at diagnosis of BCCP women compared to the Georgia population. Results Under Medicare, almost 63 % of women with any BCCP use were re-screened versus 51 % of non-BCCP users. The probability of being screened within 18 months of Medicare enrollment was 3.5 % points higher for any BCCP user and 17.7 points higher for “regular” BCCP users, compared to nonusers. Among Black non-Hispanics, the difference for any BCCP user was 13.7 % points and for regular users, 22.4 % points. A larger percentage of BCCP users were diagnosed at in situ or localized disease stage than overall. Conclusions The majority of women aging out of the GA BCCP 2000–2005 had used the program to obtain regular mammography. Regular users of GA BCCP continued to be screened within appropriate intervals once enrolled in Medicare due perhaps to educational and support components of BCCP.

Preventing premature deaths from breast and cervical cancer among underserved women in the United States: insights gained from a national cancer screening program

“…In this same study by Adams et al [27], women who had participated in the Georgia Breast and Cervical Cancer Program were more likely to be rescreened by mammography after enrollment in Medicare than non-participants. In addition, a larger percentage of the breast cancers detected among previous program participants were diagnosed at in situ or localized disease stage compared to all breast cancer cases reported to the Georgia cancer registry.…”

“…Some women may remain underinsured because they cannot afford the premiums for Medicare Part B or the premiums for supplemental insurance to cover the significant cost sharing involved with traditional fee-for-service Medicare. Adams et al [27] examined women who recently had become eligible for Medicare in Georgia. These women were far less likely to receive a mammogram within 18 months of enrollment if they had non-continuous Medicare Part B coverage or only Medicare Part A.…”

Mammography Use Among Medicare Beneficiaries After Elimination of Cost Sharing

“…We did not compare mammography use with changes in other cancer screening tests recommended in this age group (eg, colorectal cancer screening) because this screening was also subject to changes in Medicare cost sharing during this time. 7,24 We did not separately examine women with Medicare Part A only who may be less likely to receive mammography, 39 because there were <30 such women for each year. Second, elimination of cost sharing for some Medicare Advantage plans may not have occurred until 2012 27 potentially biasing findings toward the null.…”

The Reach and Health Impacts of the National Breast and Cervical Cancer Early Detection Program

“…Adams et al [16] assess breast cancer screening and incidence patterns to identify women in Georgia who are repeat users of NBCCEDP services and to observe screening patterns as these women become eligible for and transition to Medicare. This article provides important insight into the role of targeted outreach and education provided through the NBCCEDP in sustaining high levels of regular and timely screening as women age out of the NBCCEDP and become eligible for Medicare.…”