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Elder Care News
Big Bias in Breast Cancer Screening Puts Older Women
at Bottom of List
Those under 75 about
1.5 times more likely to receive a breast exam
November 28,2006 - Researchers have found a
disturbing bias in the medical judgments made about who gets screened
for breast cancer. Guess who is at the bottom? – senior citizens,
particularly those on Medicare or Medicaid. And, it is even worse if the
women are age 75 or older. Another group not likely to get a clinical
breast exam and a recommendation for a mammogram is women who do not get
routine exams from an obstetrician and gynecologist.
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Hospital Dumping of the Old and Demented Hits Los
Angeles Court
LAPD accuses several
hospitals of
dumping patients on skid row
November 17, 2006 - The hospital staff called a cab and paid the driver
to take older woman with dementia to skid row and drop her off,
according to a Los Angeles Times story reporting on “the first criminal
prosecution of a medical center accused of ‘dumping’ patients on skid
row.” Earlier this year the 63-year-old patient, Carol Ann Reyes, was
videotaped leaving in the taxi from Kaiser Permanente’s Bellflower
hospital in LA. Taken away in her gown and socks, she was found
wandering skid row streets.
Read more...
Vision Screening for Elderly Not Working: Lacks
Follow-up
Older people often fail to report vision problems,
just accept it
By Glenda Fauntleroy, Contributing Writer
Health Behavior News Service
July 28, 2006 - Vision screening tests are
recommended for older people who frequently suffer from problems with
their sight. However, a new review found there is no evidence that
community-based screening of the elderly results in any improvements in
their vision. Read
more...
Read more
Elder Care News |
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“A physician's recommendation is why many women
undergo screening in the first place,” said Rajesh Balkrishnan, the
Merrell Dow professor of pharmacy at Ohio State University.
“Foregoing these exams can increase a woman's risk
of developing an advanced stage of breast cancer. There are several
reasons why a physician may not give a patient a clinical breast exam or
recommend a mammogram.”
Balkrishnan led a study that uncovered some of
these possible reasons. The findings currently appear online at the
website of the journal
Breast Cancer Research and Treatment.
The researchers gathered data from the National
Ambulatory Medical Care Survey (NAMCS), a database run by the Centers
for Disease Control and Prevention. The NAMCS contains information on a
nationally representative sample of practicing physicians and patient
visits throughout the United States. The researchers restricted their
data set to physician office visits by women 40 and older from 1996
through 2004.
During that time, these women made an estimated 2.5
billion office visits, and physicians performed some 198 million
clinical breast exams and made 110 million recommendations for
mammograms. During a clinical breast exam, a physician feels the breast
and surrounding tissue for any irregularities.
The researchers created a number of categories in
order to determine which women were more likely to receive a clinical
breast exam or a recommendation for a mammogram. The categories included
patient age, a history of breast surgery or breast cancer diagnosis,
type of insurance coverage and physician specialty.
The researchers found that women who see an ob-gyn
for routine check ups were 18 times more likely to receive a clinical
breast exam than if they visited any other kind of physician, including
internists or family physicians.
Ob-gyns were also 13 times more likely to recommend
that their patients schedule a mammogram.
The type of insurance coverage a woman had was
also a decisive factor.
Compared to women with private health insurance,
women with public health insurance (such as Medicaid and Medicare) were
up to 30 percent less likely to receive a clinical breast exam. Doctors
were up to 55 percent less likely to recommend that these women schedule
a mammogram.
“Almost every medical association in the country
recommends that a woman 45 and older get screened annually or at least
every two years,” Balkrishnan said. “Medicare and Medicaid pay for at
least a portion of the cost of both exams for covered individuals. But
patients and physicians may not be aware of this.”
“Even if physicians are aware of this, they may
receive lower payouts from Medicare and Medicaid,” said Monali Bhosle, a
study co-author and a graduate research associate in Ohio State's
department of pharmacy practice and administration.
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“Almost every medical association in the country recommends that
a woman 45 and older get screened annually or at least every two
years. Medicare and Medicaid pay for at least a portion of the
cost of both exams for covered individuals. But patients and
physicians may not be aware of this.”
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Age also played a determining role.
Women younger than 75 were roughly 1.5 times more
likely to receive a clinical breast exam, and up to twice as likely to
get a recommendation for a mammogram.
“We confirmed another commonly held belief – that
elderly patients are less likely to get these screenings than younger
patients,” Balkrishnan said.
“This may be due to increasing dependence on
federal forms of health care insurance. Also, physicians may feel that
early detection and treatment may not be cost-effective, that such
treatment may not help to prolong life at this age.”
Women with a history of breast surgery for any
reason were 28 times more likely to receive a clinical breast exam, but
only slightly more likely (1.6 times) to receive a recommendation for a
mammogram. Women with a previous breast cancer diagnosis were 22 times
more likely to get a clinical breast examination by their doctor, and
four times more likely to get a recommendation for a mammogram.
“The effectiveness of mammography screening is
usually lower in women who had breast cancer surgery,” Bhosle said.
“Mammography picks up irregularities in the tissue, and these
irregularities may be due to the aftermath of surgery and the body's
healing process. That may be a reason why doctors didn't recommend that
many of these women get a mammogram.
“But clinical breast exams are simple and
inexpensive as compared with mammography,” she continued. “Researchers
believe that regular exams are comparable to yearly mammograms in
detecting breast cancer. Since women with a history of breast cancer and
surgery are at higher risk for breast cancer, physicians may prefer the
clinical breast exam over a mammogram.”
Editor's Notes:
Balkrishnan and Bhosle conducted the study with
Electra Paskett, the Marion N. Rowley Professor of Cancer Research
in the
School of Public Health at Ohio State and other colleagues from Ohio
State and the
University of Texas School of Public Health.
The original report was written by Holly Wagner
of Ohio State University.
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