Texas Spending Large Sums to Treat Breast Cancer

Texas Spending Large Sums to Treat Breast Cancer
(Cox News Service) -- Texas spends more than twice as much money treating women with advanced stages of breast cancer than on mammograms that would have caught the disease before it spread, state health statistics show.

This approach to fighting cancer is dictated, health care officials say, by an inescapable feature of American medicine: millions of people without health insurance.

"Those without insurance are less likely to receive preventive services, screening and the treatment that goes with early detection," said Dr. Eduardo Sanchez, a former Texas Health Commissioner.

Because one out of every four Texans does not have health insurance -- the worst rate in the nation -- it means that hundreds of thousands of women in the state are not getting regular mammograms.

Margaret Mendez, a state health official, says she gets around $6.4 million each year for a program she runs to provide mammograms to women who cannot afford them. But she said that money allows her to reach only about 3 percent of the more than 700,000 women who would be eligible.

Health officials are unanimous that without early screening, women typically are diagnosed only when the disease is in its later stages. At that point, a special Medicaid program steps in to pay for treatment for uninsured women who have breast or cervical cancer.

Ted Hughes, a spokesman for the Texas Health and Human Services Commission, says that last year the state-administered program spent $15.4 million treating women with breast cancer. This year, he said that number is expected to rise by another $200,000.

A database maintained by the Centers for Disease Control and Prevention in Atlanta that monitors, among other things, both mammogram usage and the number of Americans without health insurance paints a dismal picture of women's health care in Texas.

The state ranked 42nd in the nation last year in terms of the percentage of women not receiving regular mammograms. A disproportionate number of these women were Hispanic. While 21 percent of black women in Texas did not get a mammogram, the number rose to 38 percent among Hispanics.

Health officials say this difference mirrors the rates of uninsured in the black and Hispanic communities.

"Latinos are much more likely to not have insurance than blacks, who are only slightly less likely to have insurance than whites," Sanchez said. In fact, Federal data from 2005 shows that 55 percent of Hispanics in Texas said they did not have health insurance, versus 25 percent of African-Americans.

But Sanchez and other health officials said that cultural issues also play a role in fewer Latino women getting breast exams.

Patricia Chalela, a health care researcher in San Antonio who investigated this phenomenon, said they do not have a tradition of preventative care. "Hispanics don't see a doctor if they don't feel sick."

She also said the family-centered values in the Latino culture tends to work against women going to the doctor. "[Hispanic women] always think in terms of family first," Chalela said. "Women are the ones that take care of the family. So any needs that they have are put last."

At the same time, Chalela said some Hispanics encounter a language barrier when they try to get a mammogram. In Las Vegas, she said she found that Hispanic women went to a mammography center where the staff only spoke English.

Chalela also said there is certain fatalism about cancer. "They think it is a death sentence," she said. "They would prefer not to know." This fatalism is especially tragic since the cure rate for breast cancer is 95 percent if caught early.

But state officials like Mendez question just how important these cultural factors are in discouraging women from getting mammograms.

"It has been our experience that when you provide a service and people know about it that they are actually very happy to be informed about it and to participate," Mendez said.

Whatever the reason for the low rate of mammograms, Chalela said it has had a serious impact. Breast cancer, she said, is the leading cause of cancer deaths among Hispanic women.

Health care experts argue that there should be a greater effort to encourage Hispanic women to get mammograms. Dr. Kenneth Shine, executive vice chancellor for Health Affairs at the University of Texas, cited the success of a similar effort among African-American women, who have a higher incidence of breast cancer than Hispanics and a higher death rate.

Mary Lou Adams, who is on the nursing faculty at the University of Texas at Austin, was in charge of one such outreach program that began in 1998.

"It's one thing to go tell people to go get screened," Adams said, "but you have to tell them where to go and how this is going to be funded."

Adams trained a cadre of volunteers, promoted the program in the black community and worked with the mammography centers. She said that by 2003 the program had been responsible for 8,000 women being screened.

But today the program is longer in operation. Adams said she had to close the program because the funding ran out.

"Ours is a disease chasing medical care system as opposed to a health promoting health system," explained Sanchez. "When all is said and done it may very well be the case that if we did prevention and early detection well, in the end we could not only save lives but we could also save dollars."

source : www.intelihealth.com