The CCRP study recommends greater availability of free and low-cost mammograms, higher Medi-Cal reimbursements for digital mammography, expanded screening in remote parts of the four-county region and stronger primary care and prevention.
Humboldt County has one of the highest death rates statewide from female breast cancer, according to figures compiled by CCRP health policy analysts Jessica Van Arsdale, M.D., MPH, and Melissa Jones. Correspondingly, regional mammogram use (nearly 74 percent) is lower than statewide screening rates (84.5 percent).
“Our findings are troubling because breast cancer is a significant cause of morbidity and mortality, yet a large percentage of women in the Redwood Coast region are not receiving the recommended screening,” Van Arsdale said. “Our research shows considerable disparities among women in the region. Low-income women and those without health insurance are the least likely to receive the recommended screening, which can translate into late-stage diagnosis and a higher risk of death from the disease.”
Mammograms are designed to detect cancer in the pre-clinical stage, before symptoms appear. The CCRP analysis cites evidence that screening reduces deaths, with a greater reduction for women ages 50-74 than those aged 40-49.
The study urges greater awareness of both screening and preventive care. “New guidelines have created some confusion around when women need mammograms, and our study provides clarification,” Jones said. “Many of the policies we spell out are aimed at educating the community about breast health and cancer prevention.”
Preventive measures include a healthy diet, exercise, reduced alcohol intake and curbs on overweight and obesity.
Women who have routine health checkups are more likely to have mammograms and more likely to receive other screenings, for cervical and colorectal cancer, diabetes, cholesterol and blood pressure, according to the study. “Women respondents who had a routine checkup in the past two years were 2.3 times more likely to receive the recommended screening for breast cancer,” it says.
Yet in some of the sampled communities, more than 40 percent of women respondents said they had not been screened. A Trinity County resident said, “[I] couldn’t afford an eye exam, skim exam, pap smear, [or] mammogram.”
The CCRP analysis is titled “Disparities in Screening for Breast Cancer in the Redwood Coast Region” (CCRP Research and Policy Brief Number 7, June 2010) and is available at the CCRP’s website
It is based on data that were collected in the Rural Health Information Survey of 2006, the largest and most comprehensive research of its kind in the Humboldt-Del Norte-Trinity-Mendocino County region. Returned surveys totaled 3,003, a response rate of 12.7 percent.