Actionable Insights Newsletter

Translating research to power whole health

Issue 9   |    August 2024

Uncovering disparities in breast cancer screening and opportunities for intervention

A new study reveals a noticeable 38% of eligible women in commercially insured health plans are skipping critical breast cancer screenings, a rate higher than the national average. The greatest gaps in screening rates are observed among the socio-economically disadvantaged and in certain geographic regions, highlighting the need for targeted interventions to increase awareness and access to screenings.

Enterprise Analytics Core domain(s): health equity/SDOH, HEDIS, oncology

Summary

Background
Timely breast cancer screening is critical in early disease detection and has been shown to effectively increase survival rates. The American Cancer Society (ACS) recommends that women aged 45-54 years should undergo annual mammography, whereas those aged 55-75 should participate biennially. This guidance has been reinforced in the Healthcare Effectiveness Data and Information Set (HEDIS) reporting for breast cancer screening, which is utilized by the National Committee for Quality Assurance (NCQA) to measure the performance of health plans. Understanding health inequities or disparities in breast cancer screening will help identify sub-group of health plan members requiring targeted interventions.

Objective
To assess disparities in breast cancer screening among eligible members enrolled in commercial health plans.

Methods
The Healthcare Integrated Research Database (HIRD®) was used to identify commercially enrolled women aged 45 to 64 years with continuous coverage in the years 2020-21. Members were excluded if they had a diagnosis of breast cancer or underwent diagnostic mammography in 2019. Eligible members were identified to have undergone breast cancer screening if they had a medical claim for mammography as identified using the CPT or HCPCS codes in either 2020 or 2021. To understand disparities, the proportion with no screening was assessed by age, region, and social drivers/determinants of health (SDOH) measures, and flagged as disparity if the proportion differed from the overall non-screening rate by >5%.

Results
2.1 million commercially insured women were eligible for breast cancer screening in 2020 or 2021 based on inclusion criteria. Below are some key observations on breast cancer non-screening rate:

• The overall non-screening rate among eligible women was 38%. This rate was higher than the national average of 29-30% reported by NCQA in 2021.

• The non-screening rate varied by socio-economic status (SES) where members residing in neighborhoods in the lowest SES quartile had higher non-screening rates (41%) compared to members residing in neighborhoods in the highest SES quartile (35%).

• The greatest disparity was observed by geography, where members in the western region had the highest non-screening rate (44%).
  

• Further exploration by 5 digit zip codes of member residence identified specific areas with a non-screening rate of more than 50%. (Figure 1)
  

• Among members with no screening, 81% had a visit to a Gynecologist or Primary Care Physician (PCP) in 2020 or 2021, highlighting a need for provider awareness. Zip codes of practicing providers were identified to assess volume of non-screening members visiting them that are eligible for screening. Zip codes with at least 1,000 non-screening members were identified in California, Virginia, Georgia, and Wisconsin.

Key takeaways