title: Cost as a barrier to screening mammography among underserved women.
abstract: BACKGROUND
  Breast cancer is a troublesome health problem, particularly among underserved and minority women. Early detection through screening mammography can reduce the impact of this disease, yet it remains underused. Objective. We examined cost as a barrier to screening mammography and studied the accuracy of women's perceptions of the cost of a mammogram among a rural, low-income, tri-racial (white, Native American and African American) population in need of a mammogram.
  
  
  METHODS
  We interviewed 897 women age 40 and older, asking about cost as a barrier to mammography and perceptions about the actual costs of a screening mammogram. Face-to-face interviews were conducted between 1998 and 2000 among women participating in a randomized, controlled study to evaluate a health education intervention to improve mammography screening rates in an underserved population. All data used in these analyses were from the baseline interviews.
  
  
  RESULTS
  Cost acted as a barrier to screening mammography for a majority of the participants (53%). More than half of these women (52%), however, overestimated the cost of a screening mammogram, and overestimation of the cost was significantly related to mentioning cost as a barrier (OR 1.56, 95% CI 1.04-2.33). Higher estimates of out-of-pocket costs were associated with reporting cost as a barrier to mammography (OR 2.25, 95% CI 1.43-3.52 for $1-50 and OR 12.64, 95% CI 6.61-24.17 for >$50). Factors such as race, income and employment status were not related to reporting cost as a barrier to screening mammography.
  
  
  CONCLUSIONS
  Among a group of tri-racial, low-income, rural women who were in need of a mammogram, cost was a common barrier. Overestimating the cost, however, was significantly and positively associated with reporting cost as a barrier. Providing information about the actual cost women have to pay for mammograms may lessen the role of cost as a barrier to mammography screening, especially for underserved women, potentially improving utilization rates.
authors: Division of Health Services, Management and Policy, College of Public Health, The Ohio State University, Columbus, OH 43210, USA. mcalearney.1@osu.edu
authors: Ann Scheck
authors: AS
authors: McAlearney
authors: Katherine W
authors: KW
authors: Reeves
authors: Cathy
authors: C
authors: Tatum
authors: Electra D
authors: ED
authors: Paskett
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D016009:Chi-Square Distribution; D003365:Costs and Cost Analysis; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data; D007407:Interviews as Topic; D016015:Logistic Models; D008327:Mammography / Q000191:economics*; D008875:Middle Aged; D009657:North Carolina; D011204:Poverty Areas; D044465:White People / Q000706:statistics & numerical data