Cost as a barrier to screening mammography among underserved women.
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.
McAlearney
Ann Scheck
AS
Division of Health Services, Management and Policy, College of Public Health, The Ohio State University, Columbus, OH 43210, USA. mcalearney.1@osu.edu
Reeves
Katherine W
KW
Tatum
Cathy
C
Paskett
Electra D
ED
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