Benefits of Medicare-paid mammography lag for black women 

(18 February 2008: VIDYYA MEDICAL NEWS SERVICE) -- When Medicare began paying for older women to undergo preventive mammograms in 1991, doctors expected breast cancer mortality rates to drop. Breast cancer deaths did decrease, but new research has unveiled a discrepancy: African-American women as a group do not benefit as much as white women.

Breast cancer death rates for the two ethnic groups used to be nearly identical.

“It looks like the implementation of the Medicare benefit did a lot of good, but the benefits may not have accrued to everyone equally. White (death) rates declined faster,” said study lead author Dr. Robert Levine, professor in the family and community medicine department at Meharry Medical College in Nashville, Tenn.

Researchers have long noted racial disparities in the health and disease rates of blacks and whites in the United States. Experts offer a variety of possible explanations for the disparities, including genetics, health care discrimination and differences in education and poverty levels.

Levine and colleagues examined death certificate statistics from 1979 to 2003 to determine if Medicare’s change in policy was associated with improved mortality rates. The findings appear in the Journal of Health Care for the Poor and Underserved.

The researchers found that death rates among black and white women fell after 1993. The number of breast cancer deaths per 100,000 dropped from about 134 for both groups in 1991 to 130 among blacks and 111 among whites in 2003.

The study estimates that more than 2,400 black women might have avoided a breast cancer death if their rates had improved at the same pace as white women.

Researchers are still trying to understand the discrepancy, Levine said. One possibility is that older black women are not using the mammogram benefit as much as older white women, he said.

The study raises questions about why minority patients fail to get screening tests even when they are widely available, said Lovell Jones, director of the Center for Research on Minority Health at the University of Texas M. D. Anderson Cancer Center in Houston.

“People assume that if insurance is not an issue, the problem will go away,” Jones said. In fact, doctors need to establish partnerships with community organizations to encourage people to undergo tests, he said.

Levine RS, et al. Black-white disparities in elderly breast cancer mortality before and after implementation of Medicare benefits for screening mammography. Journal of Health Care for the Poor and Underserved 19(1), 2008.

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