October, 2016

Promote Preventive Screenings for Female Breast Health in Southeastern Pennsylvania 

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 Pennsylvania Department of Health, Bureau of Health Statistics and Research, in 2008-2012, (the most recent years available) – 3,204 women in Southeastern Pennsylvania were diagnosed with breast cancer, and an average of 664 of those women died from the disease. The mortality rate from female breast cancer in Southeastern Pennsylvania is 25.6 deaths per 100,000 women. This does not meet the Healthy People 2020 goal of 20.7 deaths per 100,000 women.

The Centers for Disease Control recommends that most women who are 50 to 74 years old should have a screening mammogram every two years to detect breast cancer in its earliest, most treatable stages.

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 their 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 Southeastern Pennsylvania, one-third of women age 18 or older (35%) did NOT have a clinical breast exam in the past year, representing approximately 593,200 women.
• Latina women are less likely to have a breast exam in the past year than any other race or ethnicity in Southeastern Pennsylvania.
o More than one-half of Latina women age 18 or older (54%) did not have a breast exam in the past year, compared with more than one-third of White (36%) and Asian women (39%), and three in ten Black women (31%).
• Women with less formal education are less likely to have a breast exam.
o Women age 18 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, 32% of women with a college degree, and 26% of women with a post-graduate degree.
• Poor women are also less likely to have a breast exam than non-poor women.
o Women age 18 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 age 50 to 74 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 Southeastern Pennsylvania women age 50-74 (38%) did NOT have a mammogram in the past year, representing an estimated 462,200 women.
• Similar to clinical breast exams, a majority of Latina women 50-74 years of age (51%) have not had a mammogram in the past year.
o They are more likely to not have had a mammogram in the past year (51%) compared with Black, Asian, and White women (27%, 28%, and 40%, respectively).
• Women age 50-74 with higher levels of educational attainment are more likely to have had a mammogram than women with less education.
o Specifically, 46% of women with less than a high school degree did not get screened in the past year, compared with 41% of women with a high school degree and 32% of women with a college degree or more.
• Women age 50-74 living below 150% of the Federal Poverty Level are slightly more likely to have not had a mammogram in the past year (44%) compared with non-poor women (36%).

Access to Care
• Uninsured women age 18 or older (70%) are more than twice as likely to not have had a breast exam in the past year compared with insured women (32%).
• Uninsured women age 50-74 (68%) are nearly twice as likely to not have had a mammogram in the past year compared with insured women (36%).

Conclusion
It is clear that breast cancer continues to present a serious health challenge to women in this country and in Southeastern Pennsylvania, 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 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] Note:  all calculations prepared by PHMC.

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

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