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4 opportunities to remove barriers to mammography compliance

Insight Article - May 19, 2022

Patient Engagement

Population Health

Patient Care Technology

Susan Ormsbee Holley MD, PhD
Screening mammograms save lives by identifying cancers early when they are smaller and more easily treated. According to the American Cancer Society, the five-year survival rate is 99% for localized disease and 86% for regional disease. For patients whose disease was metastatic when detected, the five-year survival rate is just 27%.  
 
With such high survival rates for early detection, it is surprising that compliance rates are so low. In 2018, just 66.7% of women age 40 received a mammogram in the previous two years while women age 50 or older fared only slightly better. In a study of 44 U.S. states, Black Medicaid-insured women were significantly less likely to complete breast cancer screening. 
 
Screening mammograms have declined significantly since the beginning of the COVID-19 pandemic, putting women at greater risk of breast cancer death.
 
There are multiple factors at play when it comes to women not receiving regular mammography screening. Lack of convenience, fear of the unknown, concerns about radiation, and financial issues can all act as barriers to compliance. The following are four opportunities practices can leverage to help their patients overcome those barriers.

1. Make screenings more convenient

A lack of convenience is one of the top barriers to compliance. Most imaging centers are in large, impersonal settings. Women must find a location, schedule the appointment, plan for time off work, and arrange for childcare. It’s an added trip in an already-hectic schedule.
 
The best way to overcome the convenience factor is to offer screenings within the OB/GYN or primary care practice, so women can have their mammograms at the same time as their wellness appointments.
 
While the thought of getting a mammography practice set up sounds daunting, it doesn’t have to be. Partnering with a 3D mammography services provider can remove the heavy lift by managing the installation, operations, maintenance, and certifications. Many also offer the radiologic technologists and administrative assistants to perform exams, as well as manage appointments, scheduling, and reminders.
 

2. Remove fear of the unknown through education

Many women put off getting a screening mammogram because they fear what it might find. Just the thought of having cancer and all that it entails can be a powerful deterrent to compliance. They may know someone with cancer and have witnessed their struggles.
 
The most effective way to remove this fear is to educate women about the many new options available to treat cancer if detected early. Focus on health literacy by reassuring them that most screening mammograms are normal and that only 10% are asked to return for additional testing; of those, just 0.5% will be diagnosed with cancer. It’s also important to note that today’s 3D technology provides highly detailed images that result in fewer false positives, lessening the need for subsequent imaging.

3. Provide an explanation about the screening technology

Some women may express concerns about the safety of the technology. Providers can address this concern by educating patients about the safety of mammograms, with benefits that far outweigh any theoretical risks. 
 
It is important to explain that current imaging technology uses low-dose radiation. In fact, the amount of radiation given off is about equal to two months of low-level background radiation that a woman typically experiences in her everyday life.

4. Remove financial barriers

The Affordable Care Act mandates that most private insurers, as well as Medicaid and Medicare, must pay for mammograms with no out-of-pocket costs for women 40 and older. For women who may be uninsured or underinsured, there are multiple programs that offer free or low-cost mammograms:

Saving lives

It’s not enough just to tell a woman she needs to schedule her mammogram or to hand her the screening order. Women can benefit from the chance to express their concerns and fears with their provider in a compassionate conversation. Once those concerns have been alleviated, the next best step is to provide onsite screenings in the office. Having a safe, convenient option within a familiar environment can improve compliance and save lives.

Learn moreOnsite Women's Health

About the Author

Susan Ormsbee Holley
Susan Ormsbee Holley MD, PhD
Clinical Director, Research and Development Onsite Women's Health

Susan Ormsbee Holley, MD, PhD, is a graduate of Duke University School of Medicine, where she earned her MD, and the Graduate School of Arts and Sciences where she earned her PhD in Psychological and Brain Sciences. She attended Yale University for her undergraduate studies, graduating magna cum laude with a BA in History. Dr. Holley completed her postgraduate studies at Washington University and Barnes-Jewish Hospital, St. Louis, where she did her residency in diagnostic radiology and fellowship in breast imaging at the Mallinckrodt Institute of Radiology.

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