One in five surveyed would skip costly follow-up breast cancer screening

April 26, 2023—More than 20% of patients say they would forego follow-up tests after an abnormal mammogram if they had to pay a deductible, according to a recent study.

The finding shows how health costs can interfere with the purpose of breast cancer screening—to catch cases early—and can worsen health disparities, according to experts quoted in an April 17 article in Health.

Anna Sinaiko, assistant professor of health economics and policy at Harvard T.H. Chan School of Public Health, was among those quoted. “We do know that people’s decision to use health care is sensitive to the cost that they pay out of pocket for that care,” said Sinaiko, who was not involved in the study. “If you raise costs for patients, they do use less care, even when it’s needed and appropriate.”

While Americans can currently receive an annual mammogram for free—it’s considered a preventative service, which the Affordable Care Act requires insurers to cover in full—additional imaging that can confirm a cancer diagnosis often isn’t fully covered. The study asked 714 patients at Boston Medical Center how they would respond to possibly being hit with a co-pay for follow-up breast cancer screening. Only 60% said the additional cost would not prevent them from getting the additional imaging. The remaining 40% was divided between people who said they would skip follow-up care and those who said they were not sure what their decision would be.

An additional 707 people were asked whether they would abstain from breast cancer screening altogether if they knew follow-up care would have out-of-pocket costs. Around 18% said yes—with low-income and minority patients more likely to report that they would skip care.

“Cancer outcomes are a lot better the earlier it is detected,” Sinaiko said. “We want patients to go for their mammograms to be screened so that we can catch the disease as early as possible, then it just leads to better survival and quality of life.”

Sinaiko noted that insurers—not just patients—would benefit if more people could afford diagnostic tests like additional breast imaging, as cancer caught early often requires less aggressive, expensive care later on.

Experts in the article agreed that health costs—and the risks and disparities they fuel—need to be addressed at a policy level. But on an individual level, people can minimize their costs by shopping around for insurance that offers the best coverage for diagnostics and other follow-up care, Sinaiko said.

Read the article in Health: Follow-up breast cancer imaging costs deter people from getting care, study finds

This article was updated on June 6, 2023.