State Health Secretary Nelson J. Sabatini says his department estimates that 62 percent of Maryland women age 40 or older have not had a breast X-ray in the past year and the percentage probably is even higher among poor women.
To counteract these figures, linked to more than 800 breast cancer deaths in Maryland each year, the state health department is taking steps to make breast X-rays, more commonly known as mammograms, more accessible.
"If we can do that, we can treat cancers while they are in early stages, cut treatment costs and avoid needless mortality," Sabatini said yesterday, giving a preview of a major cancer-prevention initiative that he said Gov. William Donald Schaefer would be announcing shortly.
"The governor has been very, very upset and disturbed that Maryland has one of the highest cancer rates in the country," Sabatini said. "Many forms of breast cancer are amenable to treatment. The key is early diagnosis, and that's where our emphasis is going to be."
Breast cancer is the second-leading cause of cancer deaths among women, both in Maryland and in the nation. One in nine women will develop breast cancer in their lifetime, according to the American Cancer Society.
Nearly 45,000 U.S. women are expected to die of breast cancer this year; 26,000 of those deaths could be prevented through early detection and prompt treatment, the ACS contends.
"We're going to check our claims data for the more than 97,000 female Medicaid recipients who are over 40 years old to find out which ones have not yet had a mammogram," Sabatini said. "We're in the process of identifying them now.
"Each one will receive a letter from us encouraging her to undergo the screening. We will include a list of doctors that can be seen," he said.
In this group, Sabatini said he believes the percentage who have not had a mammogram would be much higher than 62 percent, a figure that came from a recent state survey. Traditionally, poor women have not had access, have not had the money to pay for exams and their death rates have been higher, he explained.
Asked if the Medicaid claims data check would not violate the privacy of patient medical records, Sabatini replied, "No, because we would
not be not disclosing anything. We would not be telling anybody but them."
Mammograms can find a cancer when it is the size of a pinhead and up to two years before a hand can detect a lump. When breast cancer is picked up early, 91 percent of the patients survive, according to the ACS, but the survival rate drops to 69 percent when breast cancer is more advanced.
Until there is a cure, early detection -- mammography -- remains the best protection, experts agree.
According to Sabatini, the state's Interdepartmental Committee on Mandated Health Insurance Benefits estimates that early detection and treatment of breast cancer could save about $18,000 a patient. The cost of early-stage breast cancer therapy is about $7,000 a patient, compared with about $25,000 for late-stage or terminal breast cancer treatment, he said.
Maryland also has new programs that will provide better access to mammography for both insured and uninsured women -- those who make too much money to be eligible for Medicaid benefits but not enough to
pay for insurance.
As of yesterday, mammography screening is a mandated health insurance benefit in the state. Under a law passed in the 1991 General Assembly, health insurance companies will be required to provide coverage for this service to all subscribers. Many insurers will cover the full amount, others will pay up to 80 percent of the cost of the test, Sabatini said.
In addition, the state has instituted a low-cost mammography screening program. Women without health insurance who are unable to pay the $45 mammogram fee will be charged according to their ability to pay.
Low-cost mammography screening is available in Baltimore at Bon Secours Hospital, Harbor Hospital Center, Maryland General Hospital and the University of Maryland Medical Center; and at McCready Hospital in Crisfield, Sacred Heart Hospital in Cumberland and Garrett Memorial Hospital in Oakland.
The ACS guidelines recommend that women 40 through 49 years old have a mammogram every one to two years and women 50 and overhave an annual test. In addition, all women should have their breasts checked by their gynecologist every year and are encouraged to perform breast self-examinations once a month.
Studies have shown that the percentage of women who get mammograms declines with age, even though the risk of breast cancer rises. Because mammograms cost $45 to $150 and often are uncomfortable -- breast tissue is compressed to get a reading -- many older women will not undergo the test unless their doctors recommend it, doctors say.
The role of physicians in recommending mammography screening to their patients is critical, Sabatini said.