Why Poor Women Are More Likely To Die From Breast Cancer

An exhaustive review of national breast cancer cases released this week in the journal BMC Cancer found that the poorer you are, the better chance you have of dying from the disease. Epidemiologist Xue Qin Yu, formerly of the American Cancer Society, examined the records of more than 112,500 women diagnosed with breast cancer in the United States between 1998 and 2002 and tracked them until 2005. He found that women in the lowest socioeconomic areas were more inclined to have advanced-stage cancers at the time of diagnosis and to receive inadequate treatment. Black poor women fared the worst, and another statistic from 2006 found that death rates of black women were 38 percent higher than for their white peers. Not only were black women genetically predisposed to develop deadly tumors and contract the disease at a younger age, but they were four times more likely to live in the most impoverished neighborhoods.

Why the disparity? Poor women sought out fewer mammograms—cancer-screening tools that could have helped doctors locate the disease when it was easier to treat. That’s because many did not have health insurance and couldn’t afford them otherwise. Even for middle-class women, the bad economy and a slew of other factors make it difficult for women over 40 to adhere to the American Cancer Society’s recommendation that they get their boobs squished between panes of plastic once a year.

How much a mammogram actually costs is a medical mystery, requiring decoding the differential between self-pay and secretly negotiated insurance rates. To complicate matters, many facilities will give you a discount if you pay cash and spare staffers the task of filing insurance claims. On the low end, Medicare reimburses $89 for a film mammography. On the high end, a digital screening can run hundreds of dollars in New York City. Some quotes don’t include radiologist fees, which can add hundreds more. The website CostHelper.com includes cautionary postings from patients who received unexpected big bills.

But whatever the cost of mammograms, experts predict more women will find it harder to afford them. And it’s not just a lament of the estimated 7 million uninsured women between 40 and 64, of whom only four in 10 get regular mammograms, compared with eight in 10 women with private insurance. Although most states require private health insurance companies to cover mammograms (the National Women’s Law Center recently published a state-by-state online “report card”), the insurance industry has undergone such major changes in the last few years that many consumers are being asked to pay a larger percentage of the cost via rising co-pays or higher deductibles. The rapid growth of plans with deductibles of thousands of dollars means some women will have to pay for the whole thing out of pocket. Some insurance plans provide a small “preventative care” budget, but a pricey mammogram can quickly use it up, leaving little for other needs such as a general physical or annual OB/GYN exams. Is it really progress if every year you have to choose between a mammogram and a Pap smear?