Lives are Literally at Stake

In the United States, breast cancer is the second leading cause of cancer deaths in women. One in eight women will be diagnosed with cancer in her lifetime. According to the Centers for Disease Control and Prevention, 40,000 women die from breast cancer every year. Breast cancer deaths are disproportionately higher in Black women who are 40% more likely to die from breast cancer than their White counterparts. That being said, early detection with mammography reduces the number of breast cancer deaths, particularly in women over age 50

While mammography can detect early breast cancers, cost certainly has an impact on whether or not a woman will have regular screening. The Affordable Care Act eliminated cost-sharing for preventive services, including mammography. This drastically reduced the number of patients paying out-of-pocket for mammograms, but most importantly, there was an associated increase in mammography use after this provision was implemented. Mammography use increased significantly by 3.5 percentage points, from 71.3% in 2010 to 74.8% in 2013 (p=0.039).

It is reasonable to assume that elimination of cost-sharing alone is not the sole factor upon which this increase is based, but it is a very important factor. With its share of GDP over 17%, health care in the United States consumes a great fraction of our economy than any other developed country. Yet, the US continues to have poorer health outcomes in comparison to those same countries. Regardless of the amount of data supporting prevention measures to improve health outcomes, have been largely focused on disease management rather than on health promotion and disease prevention.

Now that prevention services are more affordable than ever in the history of the United States, it will be interesting to follow future US cost and health outcome trends in comparison with our counterparts in developed countries.

The ACA cost-sharing elimination provision will play a small, but important role in improving health outcomes. Essentially, this nation needs to adopt the mantra that there is health in all policies. The US must learn to value disease prevention more than disease management. Lives are, literally, at stake.

commentary by Renee Volny Darko

Abstract

BACKGROUND: We examined mammography use before and after Medicare eliminated cost sharing for screening mammography in January 2011.

METHODS: Using National Health Interview Survey data, we examined changes in mammography use between 2010 and 2013 among Medicare beneficiaries aged 65-74 years. Logistic regression and predictive margins were used to examine changes in use after adjusting for covariates.

RESULTS: In 2013, 74.7% of women reported a mammogram within 2 years, a 3.5 percentage point increase (95% confidence interval, -0.3, 7.2) compared with 2010. Increases occurred among women aged 65-69 years, unmarried women, and women with usual sources of care and 2-5 physician visits in the prior year. After adjustment, mammography use increased in 2013 versus 2010 (74.8% vs. 71.3%, P=0.039). Interactions between year and income, insurance, race, or ethnicity were not significant.

CONCLUSIONS: There was a modest increase in mammography use from 2010 to 2013 among Medicare beneficiaries aged 65-74 years, possibly consistent with an effect of eliminating Medicare cost sharing during this time. Findings suggest that eliminating cost sharing might increase use of recommended screening services.

Sabatino, SA, et al. Medical Care. 2016; 54 (4) : 394-9. PMID: 26759983