Co-payment policies and breast and cervical cancer screening in Medicaid

Social determinants of health and health inequities in breast cancer screening: a scoping review

Introduction

This scoping review aims to highlight key social determinants of health associated with breast cancer screening behavior in United States women aged ≥40  years old, identify public and private databases with SDOH data at city, state, and national levels, and share lessons learned from United States based observational studies in addressing SDOH in underserved women influencing breast cancer screening behaviors.

Methods

The Arksey and O'Malley York methodology was used as guidance for this review: (1) identifying research questions; (2) searching for relevant studies; (3) selecting studies relevant to the research questions; (4) charting the data; and (5) collating, summarizing, and reporting results.

Results

The 72 included studies were published between 2013 and 2023. Among the various SDOH identified, those related to socioeconomic status (n = 96) exhibited the highest frequency. The Health Care Access and Quality category was reported in the highest number of studies (n = 44; 61%), showing its statistical significance in relation to access to mammography. Insurance status was the most reported sub-categorical factor of Health Care Access and Quality.

Discussion

Results may inform future evidence-based interventions aiming to address the underlying factors contributing to low screening rates for breast cancer in the United States.

Availability of Financial and Medical Resources for Screening Providers and Its Impact on Cancer Screening Uptake and Intervention Programs

Interventions for residents and medical/financial resources available to screening providers can improve cancer screening rates. Yet the mechanisms by which the interactions of these factors affect the screening rates remain unknown. This study employed structural equation modeling to analyze the mechanisms underlying these factors. Data for Japanese municipalities' medical/financial status, their implementation of screening interventions, and the number of municipality-based cancer screening appointments from April 2016 to March 2017 were obtained from an open database. Five cancer screenings were included: gastric, lung, colorectal, breast, and cervical cancer screening; all are nationally recommended for population screening in Japan. We defined two latent variables, namely, intervention for residents and medical/financial resources, and then analyzed the relationships between these variables and screening rates using structural equation modeling. Models were constructed for gastric, lung, and breast cancer screening, and similar relationships were observed. With these cancer types, medical/financial resources affected the intervention for residents, directly affecting screening rates. One limitation of this study is that it only included screening by municipalities, which may cause selection bias. In conclusion, financial pressures and lack of medical resources may cause a reduction in screening intervention programs, leading to stagnant screening rates. Ensuring consistent implementation of interventions for residents may improve local and regional cancer screening rates.

Medicaid Expansions: Probing Medicaid’s Filling of the Cancer Genetic Testing and Screening Space

Cancer is the third largest source of spending for Medicaid in the United States. A working group of the American Public Health Association Genomics Forum Policy Committee reviewed 133/149 pieces of literature addressing the impact of Medicaid expansion on cancer screening and genetic testing in underserved groups and the general population. Breast and colorectal cancer screening rates improved during very early Medicaid expansion but displayed mixed improvement thereafter. Breast cancer screening rates have remained steady for Latina Medicaid enrollees; colorectal cancer screening rates have improved for African Americans. Urban areas have benefited more than rural. State programs increasingly cover BRCA1/2 and Lynch syndrome genetic testing, though testing remains underutilized in racial and ethnic groups. While increased federal matching could incentivize more states to engage in Medicaid expansion, steps need to be taken to ensure that they have an adequate distribution of resources to increase screening and testing utilization.