10/14/15

A Look at Preventive Screenings to Promote Breast Health

October is Breast Cancer Awareness Month, an annual campaign to increase awareness of the disease and to encourage preventive measures and early detection. According to The Centers for Disease Control and Prevention (CDC), in 2012, (the most recent year numbers are available)—224,147 women and 2,125 men in the United States were diagnosed with breast cancer. The Centers for Disease Control recommends that most women who are 50 to 74 years old should have a screening mammogram every two years.
Public Health Management Corporation’s Community Health Data Base (CHDB) tracks utilization of preventive health screenings, including mammograms and clinical breast exams, through the Southeastern Pennsylvania (SEPA) Household Health Survey. The Household Health Survey is a telephone survey of more than 10,000 households in the SEPA region, including Bucks, Chester, Delaware, Montgomery, and Philadelphia Counties. The survey asks female respondents about how long it has been since her last mammogram (for women 50-74) or clinical breast exam (for women 18+) and provides a range of time frames as response options.

This article uses data from the 2015 SEPA Household Health Survey to examine regional use of these important breast health screenings.

Clinical Breast Exam
According to the ACS, clinical breast exams (CBE) work side-by-side with mammograms and provide an opportunity for women and their health care provider to discuss early detection testing and possible risk factors.

• In the Southeastern Pennsylvania Region, one-third of women 18 years of age or older (35%) did NOT have a clinical breast exam, representing approximately 593,200 women.
• When looking at age breakdowns and whether or not women age 50-74 in this region are following the CDC’s guidelines, it is evident that many women are forgoing this health screening.
o Approximately 593,200 women 18+ did not receive a clinical breast exam in the past year (35%).
o Specifically, one-third of women 18-59 (35.5%) did not receive a breast exam in the past year, 29% of women 60-74, and 44% of women 75+.
• There is little variation in the percentages of women 18 years of age or older who have not received a breast exam in the past year among the Southeastern Pennsylvania Counties.
• More than one-half of Latina women 18 years of age or older (54%) did not have a breast exam in the past year, compared with more than one-third of White women (36%) and Asian women (39%), and three in ten Black women (31%).
• When looking at educational attainment, women 18 years or older who did not graduate from high school are more likely to not have had a clinical breast exam in the past year (49%) compared with 41% of women with a high school degree, 45% with a technical school degree, 34% of women with some college or a technical degree, and 32% of women with a college degree, and 26% of women with a post-graduate degree.
• Women 18 years of age or older living below 150% of the Federal Poverty Level are more likely to have forgone a clinical breast exam in the past year (45%) compared with 32% of women at or above 150% of the Federal Poverty Level.

Mammogram
According to the CDC, evidence supporting yearly mammograms for women 50 to 74 years of age is even stronger than in the past and confirms the substantial benefit for women in this age group. At the same time, mammograms do have limitations, which health care providers should discuss with their patients.

• Nearly four in ten women 50-74 years of age (38%) did NOT have a mammogram in the past year, representing an estimated 462,200 women.
• Women between the ages of 35-49 and 50-64 are slightly more likely to not have had a mammogram in the past year (45% and 34% respectively) compared with women 65+ (38%). Women 75 and older are the most likely to have forgone a mammogram in the past year (44%).
• There is little variation in the percentages of women 50-74 years of age who have not received a mammogram in the past year among the Southeastern Pennsylvania Counties.
• Similar to clinical breast exams, Latina women 50-74 years of age are more likely to not have had a mammogram in the past year (51%) compared with Black and Asian women (27% and 28%, respectively) and White women (40%).
• As educational attainment increases, the percentage of women (50-74) who did not have a mammogram in the past year decreases. Specifically, 46% of women with less than a high school degree did not get screened in the past year, 41% of women with a high school degree, 52% of women with a technical degree, 38% of women with some college, and 32% of women with a college degree or more.
• Women (50-74) living below 150% of the Federal Poverty Level are slightly more likely to have forgone a mammogram in the past year (44%) compared with non-poor women (36%).

Breast Health Screenings and Access to Care Indicators

• Uninsured women 18 years of age or older are more than two times more likely to not have had a breast exam in the past year (70%) compared with women with health coverage (32%). Similarly, uninsured women (50-74) years of age are nearly two times more likely to not have had a mammogram in the past year (68%) compared with insured women (36%).
• Women age who do not have a regular source of care are less likely to have had a breast exam (for women age 18+) (34% compared with 50%) and a mammogram (for women 50-74) (37% compared with 50%) than women who have a regular source of care.

Conclusion
It is clear that breast cancer continues to present a serious health challenge to women in this country, and mammograms and clinical breast exams play an important role in early detection and overall breast health awareness. Many women in the Southeastern Pennsylvania region, specifically, are not receiving regular clinical breast exams and mammograms. Cost-related and other barriers to health care, including a lack of health insurance and a regular source of care, are key factors in women forgoing these preventive health screenings.

[1] Source: U.S. Cancer Statistics Working Group. United States Cancer Statistics: 1999–2012 Incidence and Mortality Web-based Report. Atlanta (GA): Department of Health and Human Services, Centers for Disease Control and Prevention, and National Cancer Institute; 2015.

[2] http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-detection

 [3] http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-detection