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Cutting copays may increase women's cancer screening

By Andrew M. Seaman

NEW YORK (Reuters Health) - More women may get screened for breast and cervical cancers if they don't have to pay for the tests, according to a new study from Japan.

A year after the Japanese government started picking up the tab for Pap smears and mammograms for certain groups of women, the percentage of eligible women who got screened nearly doubled compared to a few years earlier when most women had to pay for screenings.

"This is consistent with prior research. We know that imposing out-of-pocket costs for screenings - including cancer screening services - deter their use," said Dr. Amal Trivedi, who was not involved with the new research but has studied cancer screening use.

The new study may also suggest that more U.S. women will get screened for cancer now that many of those services are covered under the 2010 Affordable Care Act, said Trivedi, from Brown University in Providence, Rhode Island.

But he added that it's hard to know exactly how the results of the program in Japan would apply to the U.S. because the two healthcare systems are different from each other.

To encourage women to be screened for breast and cervical cancers, and to target specific socioeconomic and age groups who were not generally going in for screening, the Japanese government in 2009 began giving women vouchers to get free Pap smears and mammograms every five years.

Younger women were invited to get Pap smears when they turned 20 years old and every five years after that. Women were also invited to get mammograms every five years starting when they turned 40.

In contrast, the U.S. Preventive Services Task Force, a government-backed advisory group, recommends screening for cervical cancer in women ages 21 to 65 years every three years. Or, a Pap smear and human papillomavirus (HPV) test every five years. The USPSTF also recommends women get mammograms every other year from age 50 to 74 years, but they may choose to get screened earlier.

To see whether eliminating the cost of screenings increased their use, the researchers, led by Takahiro Tabuchi of the Osaka Medical Center for Cancer and Cardiovascular Diseases, analyzed data from a survey that collects health information on Japanese citizens every three years.

Overall, they had information for more than 34,000 women.

In 2007, when women had to pay for screenings, about 22 percent of eligible women were screened for cervical cancer and about 27 percent were screened for breast cancer.

In 2010, the year after the government began picking up the cost of the screenings, about 43 percent of women were screened for both cervical and breast cancers.

Meanwhile, there was only a small increase in screenings among the women who were not eligible for the free tests.

Trivedi called the increase in screening with the vouchers "striking," but said more research is needed to know whether those women will continue to get screened in such large numbers.

The study's authors, who were not available for comment, write in the International Journal of Cancer that about 472,000 women were screened for breast cancer through the program, which prevented an estimated 461 deaths.

That is about 4 percent of the number of breast cancer deaths that are expected annually in Japan, they say.

But raising rates of screening did come at a cost of over $100 per additional screening, the report adds.

"It's not surprising that there are extra costs associated with these services. The bottom line is that we think they improve public health," Trivedi said.

SOURCE: http://bit.ly/Xf4EuF International Journal of Cancer, online March 13, 2013.

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