Study reveals out-of-pocket payments may delay breast cancer diagnosis and treatment

Researchers who surveyed women attending breast cancer screening appointments found that one in five is likely to skip additional testing after an abnormal finding on their mammogram if there is a deductible or co-payment, according to an editorial published in Radiology, a journal of the Radiological Society of North America (RSNA).

Michael Ngo, MD

“Currently, there is no out-of-pocket payment or co-payment for screening mammography since it’s covered under the ACA,” said the study’s lead author, Michael Ngo, MD, radiology resident at Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine. “However, any follow-up diagnostic imaging for an abnormal finding seen on screening mammography may require the patient to pay a co-payment or deductible, depending on their healthcare plan.”

Ngo and colleagues’ research assessed the impact that these payments had on a patient’s willingness to return for important follow-up imaging.

The researchers surveyed 932 patients presenting for breast imaging at Boston Medical Center between September 2021 and February 2022. The survey was comprised of demographic questions on race, education level, annual household income and insurance payor, as well as scenarios about utilization of breast imaging. There was a variable response rate on questions, according to the researchers.

When the participants were asked whether they would skip indicated imaging if they knew they had to pay a deductible, of 714 respondents, 151 (21.2%) said they would skip imaging, 424 (59.4%) said they would not skip imaging, and 139 (19.5%) were undecided.

“The patients who were more likely to say they would skip diagnostic imaging tended to be racial/ethnic minorities, have a lower educational level, have a lower-income household, are on Medicaid or have no insurance at all,” explained Ngo.

Researchers found that the groups with the highest percentage of responses indicating they would skip additional imaging were Hispanic (33.0%), high school educated or less (31.0%), household income less than $35,000 (27.0%) and Medicaid/uninsured (31.5%).

“Prior research has shown that these groups tend to already have lower adherence to preventive services, including breast cancer screening, and tend to have worse breast cancer outcomes,” Ngo shared. “Based on these results, these out-of-pocket payments may account for at least a part of the delay in seeking care. This, in turn, leads to delays in breast cancer diagnosis and treatment, increases overall breast cancer mortality and exacerbates existing gaps in breast cancer care in women who already have financial barriers in care.”

The survey also asked whether respondents would forgo the initial screening mammography exam if they knew they would have to pay a deductible for follow-up tests. Of 707 respondents, 129 (18.3%) said they would skip the screening mammography exam, 465 (65.8%) would not skip mammography, and 113 (16.0%) were undecided, the researchers reported.

“We hope these results can be used to advocate for legislation to eliminate out-of-pocket expenditure for screening diagnostic imaging follow-up to alleviate the existing healthcare disparities,” concluded Ngo.