When Massachusetts enacted something close to universal health insurance in 2006, proponents expected that more women would start getting screening mammograms.
A study published online in Cancer on July 25 found that mammography rates in Massachusetts for women ages 41 through 64 were 69.2 percent in 2006, 69.5 percent in 2008, and 69.0 percent in 2010. (The study authors adjusted the rates for various factors. The U.S. Preventive Services Task Force came out with its famous—or infamous—recommendation that women in their 40s not routinely undergo screening mammograms in November 2010, at the very end of the study period.)
Nancy Keating, MD, associate professor of medicine and of health care policy at Harvard Medical School and an associate physician at Brigham and Women’s Hospital, both in Boston, led the study. She told Reuters Health news service that “in retrospect, we might have been able to anticipate that.”
Why? Because almost everyone in Massachusetts had health insurance even before the 2006 reform. Only 6.4 percent of those in the state lacked insurance in 2006; the rate dropped to 1.9 in 2010. And mammography rates were already high as well. Dr. Keating told Reuters:
I actually still believe that if we looked at this in Louisiana, where a quarter of the people are uninsured, there would still be an effect. … With the Affordable Care Act, I would expect to see a difference because in the rest of the U.S. we are starting out with a much lower rate of insurance and mammography.
The study also found no significant change in early detection of breast cancer. It put the adjusted rates of diagnosis of stage I cancers at 52.2 percent in 2006, 53.5 percent in 2007, and 52.4 percent in 2008.
What to make of this? In a word, frustration. Mario Schootman, PhD, is chief of the Division of Health Behavior Research at Washington University in St. Louis and has studied the effect of poverty on cancer screening rates. He told Reuters:
Studies like the Keating one are becoming increasingly important as the [Affordable Care Act] is further implemented, potentially resulting in cost savings and improvements in public health. Unfortunately, the Keating study does not provide a definitive answer to this question.
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Related seminar: UCSF Breast Imaging and Digital Mammography (all-new release; free domestic shipping for a limited time)