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Remember the Mammogram

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A mammogram isn’t exactly the type of procedure that women across the nation line up for. Yet, the turnout among low-income women – even with health insurance – continues to trail that of upper-income women. “Health insurance is a necessary condition for screening, but it is apparently not a sufficient condition,” says Nasar Ahmed, Ph.D., associate professor of epidemiology and biostatistics at the Robert Stempel College of Public Health and Social Work at Florida International University.

What may increase the likelihood of mammography screening among low-income women is counseling, Ahmed says.

In 2011, Ahmed and a group of researchers identified 2,357 low-income women with health insurance who did not receive recommended screening mammograms and randomly assigned them to one of three groups: a control group, a group that received a reminder from their managed care organization in letter form and a group that received a second letter of reminder from their doctor and counseling if still non-compliant to screenings.

The screening rate in the control population was only 13.4 percent. That rate increased to 16.1 percent for the women who received a letter from their managed care organization. The likelihood of screenings increased 80 percent for those women who received a letter from their doctor and tripled after receiving personal counseling. The rate of the women in the personal counseling group was 27.1 percent, a significant increase but nonetheless, well below general population rates.

This study suggests that there are challenges beyond finances that face women of low-income populations, says James Marshall, a professor of oncology at the Roswell Park Cancer Institute. “A middle-class person can hop in their car and go to the clinic,” Marshall says. “How does a low-income woman find someone to watch her kids and find the transportation? Also, middle-class people take the culture of bureaucracy for granted, but it can be intimidating for low-income people.”

Marshall says that Roswell Park has effective programs where lay health counselors go into churches of low-income areas to reach women. He adds: “A person from the community can make all the difference in the message.”

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