Women at high risk for breast cancer face the costs associated with the cost of care, even when they have health insurance, a new study has found.
The findings suggest the need for more transparency in health care pricing and policies to remove financial barriers to early cancer infection.
The study, conducted by researchers at Ohio State University, included in-depth interviews with 50 women – 30 white and 20 black – who are thought to be at high risk for breast cancer based on family history and other factors. Appears in Journal of Genetic Counseling.
The researchers believe that given that women without any insurance will face serious barriers to preventive care, including genetic counseling and testing, prophylactic mastectomy, and advanced breast imaging.
But they wanted to better understand the nuances – how finances influenced decision-making in other ways and for women who had insurance.
Financial barriers appear to regularly impede access to critical information that high-risk women can only access through genetic counseling and testing and prevent them from using regular screenings that could catch cancer at the earliest and most curable stages. “
Tasleem Padamsee, co-lead author, assistant professor of health care management and policy in the state of Ohio
“For women at the highest level of risk, monetary barriers can put even the most effective preventative surgeries and medications completely out of reach,” said Padamsee, who is also part of the Ohio State Comprehensive Cancer Center.
The study provided several new insights into barriers to care, including:
- Financial constraints do not only affect the health care and preventive choices of low-income or uninsured women. Across the financial spectrum, women were concerned about the financial impact of prevention choices and avoided taking steps they could not afford or did not know if they could afford.
- When women decide whether they can afford a procedure or a test, they don’t just consider the cost of that specific care – they balance that cost with other financial demands they face, from medical debt to childcare to other illnesses they may have to pay for. family member. The authors argue that competitive requirements play a unique role in cancer protection.
- Financial considerations are affected more than the financial reality of women’s lives. They are also affected by broader social and political issues, such as the lack of price transparency by insurance companies, which often results in women having to guess which services are covered and which are not.
“Underinsurance has been a really big factor – even for those women who have private insurance, they face a lot of obstacles with the requirement to cover with genetic testing, counseling, risk reduction surgery and enhanced breast screening,” said study co-lead author Rachel J. Meadows, who worked on the research as a doctoral student at Ohio State College of Public Health.
“These women manage other priorities, including measuring care payments for chronic illnesses they currently have and managing future risk. And they have other financial requirements, including raising children and supporting other family members,” said Meadows, who currently works at the Research Center. outcomes at the JPS Health Network in Fort Worth, Texas.
Many high-risk women also worry about the risk of future discrimination if they have genetic testing, she said, although current law prevents genetic discrimination.
Studies often examine the link between income and insurance and the use of health services, but detailed discussions of this work with women can help lawyers, service providers and others better understand the subtleties of decision-making, the researchers said.
“All of this information is key to our ability to improve care. Knowing that a wide range of high-risk women are affected by financial constraints suggests that trained, cost-effective service providers could better serve them and financial assistance programs together. with information on potentially useful tests and procedures, ”Padamsee said.
The study’s findings also suggest the need for regulatory changes such as long-term safeguards against genetic discrimination and stronger requirements for insurance companies to disclose their full benefits and co-finance in a more transparent and understandable way, she said.
“These changes could improve women’s ability to access high-risk care, reduce the number and severity of future cancers, and avoid future cancer treatment costs for both patients and payers.”
Another new study involving the same group of women found that 45% of participants – and only 21% of blacks – were aware of their ability to take medication to reduce their risk of developing breast cancer. Women were more likely to have heard of these drugs, usually tamoxifen or raloxifene, if they had access to care from a specialist. The study was published in the journal BMC Women’s Health.
“The lack of awareness about chemoprevention is a critical gap in women’s ability to make health decisions,” Padamsee said.
Meadows, RJ & Padamsee, TJ (2021) Financial Constraints on Genetic Counseling and Further Risk Management Decisions Among American Women at Increased Breast Cancer Risk. Journal of Genetic Counseling. doi.org/10.1002/jgc4.1413.