More poor women get mammograms with counseling

NEW YORK (Reuters Health) - Counseling is an effective way to reach at least some of the many poor women who shy away from breast cancer screening, despite having health insurance.

That's the conclusion of a new study that found talking to a lay health worker tripled the likelihood that such women would get a mammogram.

In talking with the health workers, Nasar U. Ahmed, of Florida International University in Miami, learned that many of the women -- whose average income was less than $8,500 a year -- considered cancer a death sentence. In addition, they tended to focus less on the future and more on present tasks like getting food and taking care of sick kids.

"They are really poor, so they have immediate needs and priorities that trump cancer concerns," Ahmed told Reuters Health.

Breast cancer screening is recommended every two years in women over 50, and many doctors also advise screening in those over 40.

The women, who were 40 and older, were all enrolled in a Tennessee network of managed care organizations, but more than three-quarters hadn't made use of the offer to get free mammograms within the past few years. So the Tennessee network contacted Ahmed to try to find out what was going on and maybe come up with a solution.

"We basically tried to demystify the idea," said Ahmed, whose study appears in the journal Cancer Epidemiology, Biomarkers & Prevention.

With his colleagues, Ahmed randomly split more than 2,300 white, black and Hispanic women into three random groups of roughly the same size. One group got the usual care, that is, newsletters and pamphlets, some of which mentioned breast cancer and mammography.

Another group also received a reminder letter from their managed care organization. In the third group, if the women didn't respond to the first letter, their primary care physician sent them one, too. If they still didn't respond, they had a visit from health workers, who spent a few hours counseling them.

The counselors came from a similar low-income background and didn't only discuss cancer, Ahmed said. They would also talk about abuse, for instance, and about general health.

After one year, 13 percent of the women who received usual care had had a mammogram, compared to 16 percent of those who received a reminder and 27 percent of those who would get counseling if nothing else worked.

Compared with usual care, receiving a letter from the doctor increased the likelihood of screening by 80 percent and meeting with a counselor tripled the likelihood of screening.

Even though 27 percent might not be impressive, considering that more than half of all American women get mammograms, Ahmed said he thought it was a good start. In low-income groups with little education, access to care doesn't automatically translate into use, although many people seem to assume that, he said.

A step-wise approach to reach this demographic might very well be cost-effective, Ahmed added. He said the lay health workers in his study were paid an annual salary of $27,000 and spent no more than five hours counseling each woman. In turn, their efforts might prevent considerable healthcare costs later on.

"The whole goal is prevention," he said. "I'm really hopeful about the lay health worker approach."

SOURCE: http://link.reuters.com/cuc84m Cancer Epidemiology, Biomarkers & Prevention, online June 29, 2010.