Access to Preventive Breast and Cervical Cancer Screening Among Women with Medicaid or Commercial Insurance

Scott Pohlman (Presenter)
Hologic, Inc.

Machaon Bonafede, Truven Health Analytics, an IBM Company
Jeffrey Miller, Truven Health Analytics, an IBM Company
Isabelle Winer, Truven Health Analytics, an IBM Company
Kathleen Troeger, Hologic, Inc.
Sally Herschorn, Robert Larner College of Medicine at the University of Vermont

Public Health Statement: This study examines disparities in the utilization of preventive cancer screening services for women with commercial or Medicaid insurance across six years. Understanding these temporal patterns can inform and guide public health policy to reduce disparities and improve cancer screening rates among women.

Purpose: Describe the patterns of breast and cervical cancer screening among women by age and insurance type.

Methods/Approach: The Truven Health Analytics MarketScan Commercial and Medicaid Multi-State Databases were used to evaluate the frequency of mammography and Pap screening among women ages 40–59 years with six years of continuous insurance enrollment from 2010–2015.

Results: The analysis included 2,042,752 commercially insured women and 127,076 Medicaid-insured women. Commercially insured women received an average 2.8 mammograms during the 6-year study period; 82% received at least one mammogram, consistent across all ages. One-third (35.3%) experienced a gap between mammograms of ≥3 years, 25.4% ≥4 years, and 20.7% ≥5 years. Medicaid-insured women received an average 1.5 mammograms during the study period; 61.7% received at least one mammogram. This percentage increased with age (40–44 years: 56.1%, 45–49 years: 62.1%, 50–54 years: 64.1%, 55–59 years: 65.2%). Two-thirds (69.8%) of Medicaid-insured women had a gap between mammograms of ≥3 years, 58.6% ≥4 years, and 49.6% ≥5 years. Women who accessed mammography screening were more likely to receive a Pap test than those who did not, regardless of insurance type (commercially insured: 83.1% vs. 35.9%, Medicaid-insured: 65.5% vs. 29.4%). Among women with a mammography gap of ≥3 years, record of a Pap exam was reported for 50.7% of commercially insured and 36.8% of Medicaid-insured women.

Conclusions/Implications: Patterns of preventive screening utilization vary by type of insurance. Women who access mammography appear more likely to receive a Pap test. Many women fail to access routine breast or cervical screening, while others experience large gaps in time between exams.