For women who can’t schedule weekday screenings, Kaiser’s Cascade Park medical office offers mammograms for health plan members every Saturday from 9:30 a.m. to 6 p.m. Appointments are required: Call 503-283-7200.
Women under 60 may be too busy for mammograms; obese women may avoid them because of pain, according to a study that involves the health records of Vancouver-area Kaiser members.
The study by Kaiser Permanente researchers was one of the largest to explore why women who have health insurance put off getting mammograms.
Breast cancer is the most common cancer among women in the United States, claiming about 46,000 lives annually. About one in eight women develop breast cancer during their lifetimes.
Although regular mammograms can reduce breast cancer deaths by more than 30 percent, nearly one-third of eligible women do not get regular screenings.
“Even though we know that mammograms can save lives, many women put them off,” said study lead author Dr. Adrianne Feldstein, a physician and senior investigator with the Kaiser Permanente Center for Health Research in north Portland.
“Our study found that, even when women have access to health care, there are still barriers to getting this important screening test. We need to do more to understand these barriers and help women overcome them.”
The study looked at 4,708 women from 50 to 69 years old who are Kaiser Permanente members in Oregon and Washington. Using Kaiser’s extensive medical records, researchers were able to correlate mammogram schedules with physical and demographic information, including height and weight, age, race, length of time on the health plan and family income.
About 20 percent of the members of Kaiser Permanente Northwest live in Clark County.
The study released this week is an extension of a 2009 report that looked at a reminder system of postcards and telephone calls to get women into mammogram appointments. The women in this study, published online this week in the Journal of Women’s Health, had gone longer than 20 months since their last mammogram.
“Even with an aggressive reminder program, we found that even though response rates for mammograms increased, they didn’t get as high as we had hoped,” Feldstein said.
In this analysis, researchers found that lower mammogram rates were associated with being younger than 60, having a household income of less than $40,000, being obese, and having had health insurance for less than five years.
A subset of 677 women were mailed a survey asking why they hadn’t completed their mammograms. About half the women (340) completed the survey. The reasons they cited most often for not getting a mammogram included: it caused too much pain; they were too busy; and they felt embarrassed to have the test.
Nearly one-quarter of the women surveyed (24.7 percent) reported too much pain as a reason why they had not completed a mammogram. Obese women (31 percent) were more likely than nonobese women (19 percent) to report pain as a deterrent.
During the screening, a woman’s breast is squeezed between two plates used to take an X-ray. In some cases, it’s painful enough to make women avoid the procedure. Giving women more control over the compression of their breast might help, according to the report.
“We don’t know why obese women report more pain with mammograms,” Feldstein said. “Nearly half of the women in our study were obese, and obese women are more likely to get breast cancer, so we need to find better ways to ensure that these women are screened.”
Obesity is defined as a score of 30 on the body-mass index. It includes people who are: 5-foot-4, 174 pounds; 5-foot-6, 186 pounds; 5-foot-8, 197 pounds; and 5-foot-10, 209 pounds.
One example of an online BMI calculator is at http://nhlbisupport.com/bmi.
Women under 60 were more likely (19 percent) than those 60 and over (6 percent) to report being too busy to get a mammogram. Work-site screenings might help more women get mammograms — an approach that could help increase rates for all cancer screenings.
Since Feldstein’s 2009 report, national recommendations for mammograms have changed, adding another variable to the discussion. The U.S. Preventive Services Task Force recommends screenings every one or two years beginning at age 50.
The prior recommendations started at 40.
“Women still can get mammograms between 40 and 50 if they want them. The benefit in the 40-to-50 age group is less clear; women should discuss it with a clinician,” Feldstein said. “The evidence from 50 to 69: That’s definitive.”
Tom Vogt: 360-735-4558 or tom.vogt@columbian.com.
