Making It Easier to Access Breast Care

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

Amanda Boreen, R.N., a breast cancer nurse navigator at the Marshfield Clinic Health System in Weston, Wisconsin, sees this all 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 healthcare systems offer breast care options that fit women’s lifestyles and make care more accessible and convenient.”

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 work or caregiving situations
• Lack of access to transportation
• Living in an underserved community, healthcare desert or rural community
• Fears of exposure to Covid-19

Luckily, an increasing number of healthcare systems are searching for solutions to these and other barriers when they design their breast care programs.

Satellite clinics improve access

Many breast care programs now run satellite clinics so women can get their mammograms closer to home. One 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’s 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 goal is to increase access to quality breast care throughout the more rural service area.

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

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

Mobile mammograms bring care to you

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

Mobile mammography services vary. Some providers offer only conventional screening mammograms. Others can 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 the health fairs offered by the area’s large employers at benefits renewal time, Boreen said. “They’re also very busy visiting some of Marshfield Clinic’s smaller centers and the tribal clinics of our Native American neighbors.”

Easing financial worries

When it comes to screening mammograms, most women pay 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 healthcare, including screening mammograms for free — with no copayment, coinsurance or deductible. Medicare also covers 100% of screening mammograms. Medicaid coverage for cancer screenings varies by state and is covered in the 40 states that accepted Medicaid expansion.

But what happens when women need further testing? Kristen A. Zarfos, M.D., 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 decline needed care because of financial concerns. “I've had women who declined a follow-up diagnostic mammogram or breast biopsy due to a lack of health insurance.” “They say that, even if they get a concerning result, they can’t afford more care.”

Fortunately, some states have passed laws that require insurance companies to cover diagnostic breast imaging following an abnormal mammogram. One of the newest laws recently took effect in Connecticut. “It’s a relief because missed follow-up testing means we’re less likely to find cancer in its early stages, when it is 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 that result comes back, the vast majority of women prefer to have more testing done immediately, so we always try to complete the work-up on the same day, including a biopsy, so that they can have their results from pathology within 24 to 48 hours,” Russo said. “That’s why we’ve been doing same-day biopsies at St. Luke’s Health Network for 15 years — we were very early adopters because it’s that important.”

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

Resources exist if you need help getting a mammogram

If you’re over age 40 and something is holding you back 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 to uninsured or underserved women who have low incomes.

Boreen also suggests calling the closest health system near you to ask about mammography resources, and pointed out that your insurance company may also provide navigator services to help find care. Finally, don’t discount the value of a simple online search using terms such as “mobile mammogram near me.”

This resource was created with support from Merck.