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Analysis: Mammograms elude many

By OLGA PIERCE, UPI Health Business Correspondent

WASHINGTON, Nov. 28 (UPI) -- Mammograms can save lives by detecting breast cancer early, but two new studies point to the difficulty many women have in accessing them.

Women over age 75 and women on public insurance programs are significantly less likely to be referred for mammograms by their doctors, according to a study by Ohio State University researchers appearing this week in the journal Breast Cancer Research and Treatment.

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Meanwhile, women on rural Indian reservations are gaining greater access to the lifesaving procedure using satellite technology.

"Women over 45 should be screened for breast cancer every two to three years," Rajesh Balkrishnan, professor of pharmacy at Ohio State University and lead researcher of the mammography study, told United Press International. "Foregoing these exams can increase a woman's risk of developing an advanced stage of breast cancer."

Balkrishnan and colleagues examined more than 2.5 billion office visits by women 40 and older in the United States between 1996 and 2004. What they found was that some women are significantly more likely to receive a breast exam by their doctor and be referred for mammogram services.

Women younger than 75 were roughly 1.5 times more likely to receive a clinical breast exam and up to twice as likely to get a recommendation for a mammogram than their younger counterparts, the researchers found.

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Compared to women with private health insurance, women with public safety-net health insurance through programs like Medicaid and Medicare were 30 percent less likely to receive a clinical breast exam, according to the study, and doctors were 55 percent less likely to recommend that these women schedule a mammogram.

Both Medicare and Medicaid offer some coverage for mammograms, but patients and their doctors may not be aware of it, the study says. Another possible cause of the discrepancy is the fact that public programs tend to pay doctors a lower rate than private insurance.

"These disparities in preventive care related to breast cancer are very worrisome," Balkrishnan said. "They need to be eliminated."

The most significant difference, however, was due to the doctor and not the patient. Patients of obstetricians and gynecologists were 18 times more likely to receive an in-office breast exam and 13 times more likely to be referred for a mammogram.

"It shouldn't be that way," Balkrishnan said. "Women are much more likely to see their primary care physician."

While breast-cancer mortality rates are on the decline for white and black women, they are on the rise for American Indian women, write the authors of a study presented this week at the Radiological Society of North America annual conference.

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This may in part be due to the fact that American Indian women, who often live in rural areas and rely on the Indian Health Services, are not regularly screened for breast cancer. Breast-cancer mortality rates vary widely among Tribal Nations, ranging from 4.2 cases per 100,000 women in Tucson to 26.3 per 100,000 in North Dakota.

Looking for a possible solution to this problem, researchers from the University of Michigan Health System in Ann Arbor equipped a mobile healthcare unit with the ability to transmit digital mammography images via a commercial satellite service to the University of Michigan breast imaging division where they were interpreted in real time by trained healthcare providers.

More than 500 mammograms were performed in rural areas with a mean turnaround time of less than an hour. Forty-two of the 58 women who needed additional services based on their initial results were able to receive them at the same mobile unit within days of the initial exam, saving them the difficulty of traveling long distances for treatment.

"The results demonstrate that digital mammograms can be transmitted rapidly by satellite without loss of image quality and can be interpreted remotely," said lead researcher Marilyn Roubidoux, professor of radiology at the University of Michigan Health System. "Furthermore, patients reported high satisfaction with the professional and sensitive care they received."

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