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Quality Concerns: Arizona Struggles to Improve Mammography
Screening Rates

Physicians Urged To Recommend -- and Schedule -- Annual Mammograms for Patients

Health Services Advisory Group (HSAG), the Medicare Quality Improvement Organization (QIO) of Arizona, reports that despite the effort of physician offices, mammography facilities, and other healthcare stakeholders, mammography screening rates for Medicare Beneficiaries have remained virtually unchanged over the past three years.

Statewide rates were 59.8% in January 2002, and the latest quarterly data revealed an insignificant increase to 60.4%. The results reflect Medicare Fee-For-Service claims in Arizona.

“Medicare beneficiaries in Arizona are not taking advantage of an important covered service. The risk of breast cancer increases with age, so screening mammograms are even more important women over 65,” said Anita Murcko, MD, FACP, HSAG Chief Medical Officer.

Mammography Reminders: Medicare pays for routine screening mammograms annually for women over 40. Most health plans cover mammography Information on free or low-cost mammograms can be obtained from: American Cancer Society 1-800-ACS-2345 ADHS Well Woman Healthcheck Program 1-888-257-8502

The Center for Disease Control (CDC) reports that one in eight women will develop breast cancer during her lifetime, and in our state breast cancer is the leading form of cancer among women. In 2003, more than 3,900 women were diagnosed, and nearly 700 women died from breast cancer complications in Arizona.

Mammograms can detect cancer up to two years before a lump can be felt; and that more than 97 percent of women whose breast cancer is found and treated early with no spreading beyond the breast, will survive.

A 2003 RAND study offers insight into why women do not get life-saving mammograms. According to the survey, some women:

• are afraid of pain or discomfort associated with mammograms
• are afraid of finding out they might have breast cancer
• do not generally see a healthcare professional unless they are ill
• may not fully understand their Medicare Part B benefits
• or fail to appreciate the importance of getting an annual mammogram

The RAND study also confirmed that women view their practitioners as a valuable source for healthcare advice -- including mammograms.

Unfortunately, another study shows that women age 65 and older are less likely to get mammograms than younger women (55% vs. 65% for women ages 40-49).

“Physician recommendations are important,” says Elaine Nelson, RN, HSAG Clinical Quality Specialist, “but we have found that if the physician office staff can schedule the mammography appointment before the patient leaves the office, more women will follow through with the important procedure.”

Seniors especially will benefit from scheduling assistance. “Activities that we take for granted such as locating a phone number, dialing the phone, and navigating through an automated phone system, can all be difficult for older patients.”

“Also, with the appointment already scheduled, some patients might feel more obligated to follow-though,” Nelson adds.

According to Dr. Murcko, Arizona's target is the Healthy People 2010 goal of 70 percent.

“By recommending annual mammograms and assisting patients by scheduling or facilitating the mammography appointment, physicians and office staff play a crucial role in helping Arizona's women achieve this important goal,” said Murcko.