The Shriver Report and Access to Breast Cancer Care

The following blog appeared in The Huffington Post on January 20, 2014.

Maria Shriver’s report this week on the economic crisis plaguing American women reinforces what those of us who work with vulnerable women see every day.  By “vulnerable,” I mean women without insurance, without enough insurance, or without financial resources to access the health care system.  Their plight is even more desperate when they are trying to access care because of a lump they’ve just discovered in their breast.

Shriver’s report is crucial to understanding a wide range of issues of vital importance to the women, families and future of this nation.  To me, two lines in this report sum up key messages:  “Access to affordable health care is essential to women’s economic security and well-being;” and “Leave out the women, and you don’t have a full and robust economy. Lead with the women, and you do.”

At Susan G. Komen, we work with low-income and uninsured women in thousands of communities across the country. Getting them the services they need has been a priority for our organization for all of our 32 years.  And so it is enormously disheartening, in this day and age, to see women in our country at one of our free mammogram clinics with breast tumors that are likely to be advanced cancer – even some with tumors breaking through their skin. Had their cancers been detected earlier, they might have had more options or perhaps a better prognosis.

We don’t know all of the reasons why women delay seeking care, but we have good anecdotal insights.  Fear and denial certainly play a role – some think that ignoring the problem may make it go away.  As a practicing physician, I unfortunately saw that all too often.

But economics, especially among women, is likely the overriding issue.  As Shriver’s report notes, a third of American women are living at or near poverty levels.  Many are single working mothers.  And women hold 62 percent of minimum-wage jobs, where taking a sick day could mean the end of the job. Those who don’t qualify for Medicaid, and who don’t have insurance, are told to bring the money for their procedures to the clinic ahead of time.  The $200 that a mammogram might cost could pay for food for the family, forcing these moms to make tough choices.  As a result, too many women delay seeking help.

Unfortunately, with cancer, the longer the wait, the fewer the options.

The economic impact of this unequal access to breast cancer care is considerable: the C-Change organization estimates we can save at least $674 million annually in direct medical costs alone by reducing the disparities in breast cancer access and treatment. This is money spent on the expensive, prolonged therapies that late-stage disease often requires.  C-Change estimates at least another $116 million in indirect costs of these disparities in terms of lost wages and productivity.

Members of our Scientific Advisory Board estimate that we could reduce breast cancer death rates by a third if everyone had access to and utilized high-quality cancer care. That translates to roughly 12,000 women and men who might otherwise survive.

I’m hopeful that some of these roadblocks will be reduced through the Affordable Care Act, which will make health insurance available to more women living on the brink, offer mammograms without a copayment, and may result in women accessing health care early enough to make a difference in their outcomes.

As the Shriver report points out, expanding access to Medicaid services would also help substantially, although only about half of the states have expanded their programs.  This is why we at Komen have included expanded Medicaid access as one of our advocacy priorities for 2014.  We also will continue efforts to preserve the National Breast and Cervical Cancer Early Detection Program that provides screenings for low-income and uninsured women, and we’ll advocate for other measures, such as oral chemotherapy legislation that can make cancer treatment more affordable and convenient for all women.

President Obama will be using findings from the Shriver report to inform a summit on working families this spring.  We hope that women’s access to quality health care is high on the summit agenda.  In the meantime, we’re grateful to Maria Shriver for spurring the national conversation on the economic challenges of women in our nation.

If you need breast health services and can’t afford them, please contact Komen’s national helpline at 1-877-GO-KOMEN (1-877-465-6636) or contact a local Komen Affiliate. You can find a Komen Affiliate in your area at this link.

About the author

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Judy Salerno has written 11 articles for Susan G. Komen® | Blog

Judith A. Salerno, M.D., M.S., is the President and Chief Executive Officer of Susan G. Komen®, responsible for the day-to-day operation of the organization and for setting Komen’s strategic vision. Dr. Salerno brings extensive experience in research, public health policy and community health to the role. Before joining Komen, she was the Leonard D. Schaeffer Executive Officer of the Institute of Medicine (IOM) of the National Academies, serving as executive director and chief operating officer of the Institute.