FIGURE 3-3 Poverty is a greater barrier to mammography than race or ethnicity.

SOURCE: National Center for Health Statistics, 2003.

frustrate screening attempts and create barriers for women seeking preventive screenings.45,50 African American women may also face cultural barriers to obtaining a mammogram, including false beliefs about cancer, traditions that discourage seeking medical care, and difficulties in communicating with their physicians.8,58,61,72,82,83

A number of programs have been initiated since 1990 to reduce the financial barriers to mammography rates in all groups. In 1991, Medicare began to cover part of the cost of screening mammograms, but screening rates failed to increase. In 1998, the co-payment and deductibles for the Medicare screening services were eliminated. All women aged 65 and older are eligible for Medicare and 94 percent of them choose the option. Yet, as noted earlier, these are the African-American women who suffer the greatest racial disparity in breast cancer mortality, suggesting that the lack of health insurance is not the predominant cause.

The Centers for Disease Control and Prevention’s (CDC’s) National Breast and Cervical Cancer Detection Program was launched in 1990 to provide screening services for uninsured women who were not eligible for Medicaid. Since then it has provided nearly 4 million screenings to 1.6 million women. In principle, this program should reduce the disparities in mortality that arise from lack of health insurance, although it has never been funded well enough to cover all, or even most, eligible women. For example, in 2002 approximately 400,000 women received at least one Pap test, mammogram, or clinical breast exam through the CDC program.26 By



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