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Medicare News
Black Women Did Not Benefit as Much as White Women
from Medicare-Paid Mammograms
Breast cancer death rates for the two ethnic groups
used to be nearly identical
By Randy Dotinga, Contributing Writer
Health Behavior News Service
 Feb. 19, 2008 - When Medicare began paying for
older women to undergo preventive mammograms in 1991, doctors expected
breast cancer mortality rates to drop. And, as expected, breast cancer
deaths did decrease, but new research has unveiled a discrepancy:
African-American women as a group do not benefit as much as white women.
Breast cancer death rates for the two ethnic groups
used to be nearly identical.
It looks like the implementation of the Medicare
benefit did a lot of good, but the benefits may not have accrued to
everyone equally. White (death) rates declined faster, said study lead
author Dr. Robert Levine, professor in the family and community medicine
department at Meharry Medical College in Nashville, Tenn.
Researchers have long noted racial disparities in
the health and disease rates of blacks and whites in the United States.
Experts offer a variety of possible explanations for the disparities,
including genetics, health care discrimination and differences in
education and poverty levels.
Levine and colleagues examined death certificate
statistics from 1979 to 2003 to determine if Medicares change in policy
was associated with improved mortality rates. The findings appear in the
Journal of Health Care for the Poor and Underserved.
The researchers found that death rates among black
and white women fell after 1993. The number of breast cancer deaths per
100,000 dropped from about 134 for both groups in 1991 to 130 among
blacks and 111 among whites in 2003.
The study estimates that more than 2,400 black
women might have avoided a breast cancer death if their rates had
improved at the same pace as white women.
Researchers are still trying to understand the
discrepancy, Levine said. One possibility is that older black women are
not using the mammogram benefit as much as older white women, he said.
The study raises questions about why minority
patients fail to get screening tests even when they are widely
available, said Lovell Jones, director of the Center for Research on
Minority Health at the University of Texas M. D. Anderson Cancer Center
in Houston.
People assume that if insurance is not an issue,
the problem will go away, Jones said. In fact, doctors need to
establish partnerships with community organizations to encourage people
to undergo tests, he said.
Editors Notes:
Journal of Health Care for the Poor and
Underserved: Contact Editor Virginia M. Brennan at (615) 327-6819 or
vbrennan@mmc.edu. Online, visit http://www.press.jhu.edu/journals/journal_of_health_care_for_the_poor_and_underserved/
Levine RS, et al. Black-white disparities in
elderly breast cancer mortality before and after implementation of
Medicare benefits for screening mammography. Journal of Health Care for
the Poor and Underserved 19(1), 2008.
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