Facilitate access to breast cancer care

Making access to breast care easier

You know the famous air travel analogy about putting on your own oxygen mask first so you can help others safely? For many women, this is also true when it comes to keeping up with preventative breast care. Mammography screening it is the most effective tool for finding breast cancer in its early stages, yet many women find it difficult to access this potentially life-saving test.

Amanda Boreen, RN, breast cancer nurse navigator at Marshfield Clinic Health System in Weston, Wisconsin, she sees him too often. “If we don’t take care of ourselves as women, how can we take care of others or do the things we want to do in life?” she said. “It’s really important that health systems offer breast care options that fit women’s lifestyles and make care more accessible and affordable.”

There are many reasons why women might fall behind in getting their annual mammograms and physicals. Possible barriers include:

  • Cost
  • Lack of health insurance
  • Lack of flexible working or caring situations
  • Lack of access to transportation
  • Living in an underserved community, sanitary desert, or rural community
  • Fears of exposure to Covid-19

Fortunately, a growing number of health systems are looking for solutions to these and other barriers when designing their breast care programs.

Satellite clinics improve access

Many breast care programs now operate satellite clinics so women can get their mammograms closer to home. An example is the Marshfield Clinic Breast Care Program, a service of the Marshfield Clinic Health System. The health system operates 11 hospitals and more than 50 clinics in 25 counties in northern Wisconsin and Michigan.

Marshfield Clinic facilities include three full-service breast centers: one breast center on its main campus in Marshfield, one 45 miles away in Wausau, and the other 80 miles away in Eau Claire. The aim is to increase access to quality breast care throughout the more rural service area.

St. Luke’s University Health Network in eastern Pennsylvania’s Lehigh Valley also makes breast services widely available at its 12 hospitals and one regional breast center. “We use a hub and spoke structure so women get convenient access to screening at many sites in our network,” she said Joseph P. Russo, MD, breast radiologist and head of female imaging at St. Luke’s. “Then, if more assistance is needed, we consolidate and coordinate diagnostic care at our regional breast center.”

St. Luke’s offers daily early morning mammography appointments and evening appointments one day a week. Other locations may also offer weekend, same-day, or even walk-in mammograms.

Mobile mammograms bring you care

Sometimes it’s not enough just to add hours. Mobile mammography eliminates transportation barriers by bringing breast care to women where they live or work. These mobile units are typically buses retrofitted to include one or two mammography rooms, as well as changing rooms and waiting areas.

Mobile mammography services vary. Some providers only offer conventional screening mammograms. Others may provide diagnostic mammograms; digital breast tomosynthesis, also known as 3D mammography; breast exams; and even primary care appointments.

The Marshfield Clinic’s mobile mammography unit attends health fairs offered by large area employers upon benefits renewal, Boreen said. “They’re also very busy visiting some of the smaller Marshfield Clinic centers and the tribal clinics of our Native American neighbors.”

Ease your financial worries

When it comes to mammography screening, most women pay for nothing out of pocket. That’s because the Affordable Care Act, commonly known as Obamacare, requires private health insurance companies to cover women’s preventive health care, including screening mammograms, free of charge, without copay, coinsurance or deductible. Medicare it also covers 100% of screening mammograms. Medicaid coverage for cancer screenings varies by state and is covered in the 40 accepting states Medicaid expansion.

But what happens when women need more testing? Kristen A. Zarfos, MD, FACS, a breast surgeon at Saint Francis Hospital in Hartford, Connecticut, and a member of HealthyWomen’s Women’s Health Advisory Council, says women sometimes refuse needed care due to financial issues . “I’ve had women decline a follow-up diagnostic mammogram or breast biopsy due to lack of health insurance.” “They say that even if they get a worrying result, they can’t afford any further treatment.”

Luckily, some states they passed laws requiring insurance companies to cover diagnostic imaging of the breast following an abnormal mammogram. One of latest read recently enacted in Connecticut. “It’s a relief because not following up testing means we’re less likely to find cancer in its early stages, when it’s most treatable,” Zarfos said.

Same-day biopsies bring peace of mind

One of the most important improvements in breast cancer screening has been the push to offer same-day breast biopsies following an abnormal mammogram. “Once the result is back, the vast majority of women prefer more tests to be done immediately, so we always try to complete the work-up the same day, including a biopsy, so they can have their results from the pathology within 24 to 48 hours,” Russo said. “That’s why we’ve been performing same-day biopsies at St. Luke’s Health Network for 15 years—we were an early adopter because it’s so important.”

According to Zarfos, St. Francis in Hartford also strives to achieve this goal. “Usually you’ll see a breast surgeon or physician assistant the same day as an abnormal mammogram, and we’ll try to biopsy the breast the same day,” he said. “Women find it brings them so much peace of mind that they come from all over the state for this shoot.”

Resources exist if you need help getting a mammogram

If you’re over 40 and something is keeping you from getting a mammogram, there are resources that can help.

THE National Breast and Cervical Cancer Early Detection Program (NBCCEDP) provides access to breast and cervical cancer screening for uninsured or underprivileged women who are on low incomes.

Boreen also suggests calling the nearest health care system near you to ask about mammography resources, and pointed out that your insurance company can also provide navigation services to help you find treatment. Finally, don’t underestimate the value of a simple online search using terms like “mobile mammogram near me.”

This resource was created with support from Merck.