Blue Review
A newsletter for physician, professional, facility, ancillary and Medicaid providers

September 2018

Women’s Health Alert: Are Your Patients Getting Their Mammograms?

Screening mammography can reduce mortality from breast cancer in women who are asymptomatic and at average risk for the disease.1 Although age guidelines for the first screening and interval screenings may differ,2 the importance of screening remains the same: to detect cancer at an earlier stage when the patient’s treatment options and chances of survival are higher. When ordering mammograms, please consider potential barriers that may be impacting your patients’ adherence to your screening recommendations.

Breast Cancer Prevalence

According to the Centers for Disease Control and Prevention (CDC), breast cancer continues to be the second leading cause of cancer death among American women and the leading cause of cancer death for Hispanic women in the U.S. Additionally, according to the CDC, the risk of getting breast cancer has not changed overall in the past 10 years – one in every eight women will be diagnosed with breast cancer over the course of a lifetime. The risk, however, has increased for African-American, Asian and Pacific Islander women in the U.S.3

For the current year, the American Cancer Society estimates that:

  • 266,120 U.S. women will be diagnosed with breast cancer
  • About 40,920 women will die from this type of cancer

In Texas, the incidence rate for breast cancer in 2017 was 112 new cases per 100,000 women.5 It is estimated that in 2018:

  • 18,260 cases of breast cancer will be diagnosed
  • There will be about 2,880 deaths as a result4
  • The incidence rate for breast cancer will be 112 new cases per 100,000 women in Texas.5

How to Encourage Screenings

Breast cancer is a serious, potentially life-threatening disease, and early detection is vital to increasing each patient's chance for survival. Blue Cross and Blue Shield of Texas (BCBSTX) values your diligence in encouraging your patients to get mammograms and other recommended screenings according to the U.S. Preventive Services Task Force (USPSTF) guidelines*. But it doesn't end there, because the message may not be reaching certain populations, or if it is, some individuals may not be taking appropriate action.

BCBSTX has identified areas of opportunity for increased awareness among some of our members based on claims data. For example, breast cancer screening rates among members are lagging, despite ongoing member education and outreach efforts. You may be ordering mammograms, but there may be several factors that are preventing patients from following through. We are seeking your help to bridge the gap.

What Are the Potential Barriers Preventing Patients from Getting Mammograms?

When talking with your patients, it's important to recognize potential disparities in breast cancer screening, particularly among some minority populations. The Susan G. Komen® website compares mammography screening rates among different groups of people and offers several points to consider.6

  • Lack of Awareness – Some women may not be aware of the importance of routine screening and that their risk increases with age. If diagnosed, they may not understand the importance of acting quickly.
  • Cost Concerns – Patients in low-income households may be concerned about taking time off from work for doctor appointments. They may not think they can afford screening or treatment.
  • Limited Access – A patient may make it to an annual visit, but it may be hard to arrange for additional visits such as a screening or other follow-up appointments. There may not be a screening facility close to where the patient lives or works. They may not have transportation.
  • Fear – Some patients may be worried that screening will be painful, dangerous or ineffective. They may be apprehensive about results. They may be afraid their insurance will not cover treatment if it becomes necessary.
  • Lack of Support – Some patients may be serving as primary caregivers for children or other family members. They may not have anyone else to help them if they need to make their own health top priority.

What Can You Do to Help?

Some members may need more than a written order for screening. Here are some suggestions to help make sure your patients follow through:

  • Offer to make the appointment for your patient. Print instructions and circle important details. Make sure patients have a number to call if they have questions.
  • Talk about potential costs. In most cases, a mammogram is a covered preventive service benefit. Remind patients they can call the number on their member ID card for additional information regarding their health care benefits
  • Make sure your patients understand. Ask questions, such as: Do you understand why screening is important? When are you going? Where are you going? Do you have transportation? Are there any reasons that may prevent you from keeping your appointment?
  • Encourage your patients to learn more. Direct them to additional resources for information and support.
  • Follow up after patients leave your office. Call or mail a letter to confirm your patient completed their screening.

Resources for Providers

Many organizations offer excellent resources, including:

Resources for Members

BCBSTX conducts member education campaigns to help increase awareness of preventive care opportunities, such as scheduling annual routine physical exams. Reminders about mammograms and other important topics also are published on our Connect community.

Other resources you may wish to share with your patients include:

  • CDC – The Breast Cancer: What You Need to Know fact sheet provides a quick overview of important details such as risk factors and symptoms.
  • Susan G. Komen – Patients may visit komen.org to learn more about screening and sign up for reminders. Patients may also contact the Breast Care Helpline at 877-465-6636 for breast health and breast cancer information, and free, professional support services.

*There are multiple guidelines for breast cancer screening. In addition to USPSTF guidelines, also refer to the American College of Obstetricians and Gynecologists (ACOG) Statement on Breast Cancer Screening Guidelines, and the American Cancer Society’s Recommendations for the Early Detection of Breast Cancer.

Sources:
1, 2 USPSTF: Final Recommendation Statement, Breast Cancer Screening, Jan. 2016
3 CDC: Basic Information About Breast Cancer, June 13, 2018
4 American Cancer Society: Cancer Statistics Center, 2018
5 Texas Health and Human Services: 2018 Female Breast Cancer Fact Sheet - Texas, April 30, 2018
6 Susan G. Komen: Comparing Breast Cancer Screening Rates Among Different Groups, July 10, 2018

The Susan G. Komen Foundation is an independent, third-party organization. BCBSTX makes no endorsement, representations or warranties regarding any products or services provided by third-party organizations such as Susan G. Komen. If you have any questions about the products or services provided by such organizations, you should contact those organizations directly.

The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment. The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations, and exclusions