The awareness of breast cancer and the companion calls-to-action have truly been amplified during this decade. Recently, in honor of breast cancer awareness, football teams wore pink sneakers, the so-called “real” refs wore pink wrist bands, the well-promoted and participated Susan G. Komen three-day walk ended with the usual enthusiasm and broadcast media attention.
Back in the late nineties, I worked at a corporation that was centered on women’s health. We proactively reached out to organizations associated with women’s health, including Susan G. Komen, and offered to bring our resources to bear to assist in raising awareness and amplifying their messages. In those days the only talk about breast cancer seemed to occur when a teary-eyed friend or co-worker would whisper that she discovered a lump. So it is all wonderful that this health issue and the call to get mammograms have reached the population at large such that even teenage boys drive cars with pink ribbons on them. However, all of this awareness masks some serious issues.
One issue is access. While this year some insurers began covering individuals’ mammogram costs via federal funds, there is still confusion and inconsistency. Since turning 40, I never thought about access because every year since then my annual GYN visit was accompanied with an order for a mammogram. It all flowed easily and smoothly. That was until one year when my travel schedule was going to intensify and so would not permit me to maintain my annual routine on its usual schedule. I would need to have my mammogram a couple of weeks sooner than its anniversary or forego it for the year due to business matters.
Even though I had worked with health insurers all over the country over the years and was aware of limits, I had felt the love, compassion and caring that eminated from the world around me concerning breast cancer and the need for mammograms. I noted that even normally aloof and remote TV and radio broadcasters talked to me like girlfriends when they spoke about breast cancer every year in October. They would urge girlfriends to urge girlfriends to get their mammograms. They showed women from all walks of life and socioeconomic status on TV during their breast cancer segments. So I naively thought the world was now cooperating and enabling all women to get a needed mammogram.
Needless to say, I was shocked when I was denied a mammogram. Just flat out denied from the people in the traveling mammogram bus to the insurer’s representative on the phone. I was stunned at these roadblocks but I persisted. Finally I spoke to yet another staffer in a mamm van about my frustration. She said that if I was willing to pay for it myself it could be arranged, though individual payment was not encouraged. I felt awash with relief but I wondered about women who could not afford the nearly $300 price. No doubt women in my company who worked with me had different income situations and family obligations. I realized that these women would be forced to forego their test as the cost would be prohibitive. This led me to wonder about the forces driving women to act.
So the second issue is the cost for mammograms and other preventive care tests, and so the driver behind the call to testing. There is an industry that benefits hugely from such high costs for preventive care. High costs persist and get higher because the federal government and employers currently pay it. While we do too via taxes, it is less apparent. Costs for these tests are prohibitive for the working poor. Certainly businesses should expect to be paid for services rendered but in cases of health the power of consumer demand often benefits a third party more than the consumer.
In matters that concern health we should probably not adopt the mantra “just do it” without understanding why we should do it. Does the medical evidence truly support the value of annual mammograms? Whom does the annual call to action truly benefit – women or the businesses that offer the tests? In the best of all worlds, the benefit to an industry should result from optimally and transparently serving the needs of patients.