Beginning in 2010, women under the age of 50 in California will no longer be eligible for free screenings for breast cancer, the state’s Department of Public Health announced this week. In addition, no new patients will be admitted into the state’s Every Woman Counts program from January 1 until the beginning of the next fiscal year on June 30.
The decision, coming less than a month after the Obama administration’s United States Preventive Services Task Force (USPSTF) issued its recommendation that women under 50 not undergo yearly screenings for breast cancer, will result in thousands of women going undiagnosed and untreated for life-threatening cancers.
Every Woman Counts pays the cost of mammograms for women earning less than 200 percent of the federal poverty level, which is currently $21,660 for a single woman and $36,620 for a family of three. It primarily covers uninsured women not enrolled in the state’s Medicaid program, Medi-Cal, as well as those who have insurance that does not compensate for preventive screenings.
State health officer Mark Horton told the press that the program’s cuts were made on the basis of “unprecedented fiscal challenges.” Mammograms in California were originally covered from tobacco sales taxes, but in recent years smoking rates have declined and state budget administrators have not supplemented the funding from other sources, even as need has grown.
In the past fiscal year, the program served 311,000 women, at a cost of some $51.6 million dollars. This year, however, funding fell short due to increasing medical costs and a growth in the demand for subsidized care. The latter of these is driven by a rise in unemployment and the loss for many workers of employer-sponsored health insurance.
Al Lundeen, a spokesman for the California Department of Health, told The Sacramento Bee December 16, “It isn't that we don't want to provide these services. We can't afford to provide these services.”
Alecia Sanchez, director of state legislative advocacy for the American Cancer Society in California, told the World Socialist Web Site that the cuts were “a huge step backwards. We’re extremely concerned about the impact on uninsured women in the state.”
Sanchez noted, “Any one person being turned away is troubling. The decision flies in the face of what is appropriate and would save the most lives. Regardless of what the impetus is, it means real women and real lives.”
At least 20 other states, citing severe budget shortfalls, have cut free cancer screening programs for the poor or had to turn people away over the past year, according to an informal survey of state agencies by the American Cancer Society’s Cancer Action Network (CAN).
Between July 2008 and April 2009, the CAN found that many states were cutting back preventive health budgets and turning away poor people seeking mammograms, Pap smears, and other cancer screenings. Even without budget cuts, many state programs with flat funding levels are faced with higher costs and more need. As a result, they end up turning eligible people away.
New York, which previously screened women of all ages for free, has announced that it only test women over 50 after $3.5 billion in budget cuts.
An Associated Press investigation into the cuts, published December 13, found that many local providers will be forced to substantially reduce services. In New York, the AP reported, providers in Manhattan, Brooklyn and western Queens, and in Nassau, Suffolk and Westchester counties projected 15,000 fewer free mammograms would be performed for the fiscal year ending April 2010 over the last year.
Oregon, with 57,000 women eligible for screening, must now ration these numbers down to 6,000 annually, according to Amy Manchester Harris, manager of the Breast and Cervical Cancer Program. Shari House, owner of the Pearl Health Center in Portland, told the Associated Press how difficult it was turning women away who did not qualify. “It’s pretty painful. They get angry, they get depressed, they get hopeless,” she said. “It’s like having a door slammed in your face.”
State funding for Ohio’s mammogram program was set at $2.5 million for 2008-2009, but this year that dropped to $700,000. At least 17,000 women were treated last year by Ohio, but now this number will shrink to 14,000.
In total, 14 states have had to cut from their budgets money allocated to cancer prevention, including: Colorado, Montana, Illinois, Alabama, Minnesota, Connecticut, South Carolina, Utah, Missouri, Washington, Ohio, Massachusetts, Pennsylvania and Arkansas.
Dr. Otis Brawley, chief medical officer for the American Cancer Society, told the AP, “This is rationing of health care by offering (screenings) only in the first half of the fiscal year, or by cutting back on those programs…. It’s rationing that is leading to people dying.”
According to a recent Government Accountability Office (GAO) report, state-level data on women technically eligible for screening suggest that there is only adequate funding to cover one out of every five of these individuals. Prior to the program cuts in California, funding covered one out of two eligible women in the state.
The GAO report compared federal screening data with estimates of low-income uninsured women and found that from 2005 through 2006, only 15 percent of eligible women received a mammogram from the federal-funded Early Detection Program. Providers screened another quarter, while some 60 percent were not screened at all. For Pap tests, the GAO estimated that from 2004 through 2006, 9 percent were screened by the program, 59 percent by other providers; a third were not screened at all. Because these figures were collected well before the onset of the economic crisis they substantially understate the current crisis in medical access for millions of poor and uninsured women.
Breast cancer is by far the most common form of cancer among women. In the US, over 192,000 cases are diagnosed each year, and an estimated 40,000 women die of the disease annually. The American Cancer Society (ACS) estimates that 34,600 women between the ages of 40 and 49 will be diagnosed with breast cancer this year. Some 4,300 women in their 40s will die from breast cancer in 2009.
Those without insurance have a high risk of dying of cancer after it develops, because it is not detected at an early stage. According to the ACS, only a third of uninsured women get breast cancer screening.
The ACS continues to recommend, in opposition to the Obama administration’s policy revision, that women get themselves screened annually after 40, while the American College of Obstetricians and Gynecologists advises women over 40 to get a mammogram every one or two years after 40, and annually after 50.
The scientific consensus is that women who are diagnosed earlier in their lives for breast cancer have a higher survival rate than those who are diagnosed later in life. The American Cancer Society estimates that fully 98 percent of women have a chance of surviving if they are treated early. During Stages II and III the survival rate falls to 84 percent. After stage IV, when cancer is well advanced, the survival rate drops to 27 percent.