abstract: 'BACKGROUND: Rural US women experience disparities in breast cancer

  screening and outcomes. In 2006, a national rural health insurance

  provider, the National Rural Electric Cooperative Association (NRECA),

  eliminated out-of-pocket costs for screening mammography. METHODS: This

  study evaluated the elimination of cost sharing as a natural experiment:

  it compared trends in screening before and after the policy change.

  NRECA insurance claims data were used to identify all women aged 40 to

  64 years who were eligible for breast cancer screening, and mammography

  utilization from 1998 through 2011 was evaluated. Repeated measures

  regression models were used to evaluate changes in utilization over time

  and the association between screening and sociodemographic factors.

  RESULTS: The analysis was based on 45,738 women enrolled in the NRECA

  membership database for an average of 6.1 years and included 279,940

  person-years of enrollment. Between 1998 and 2011, the annual screening

  rate increased from 35\% to a peak of 50\% among women aged 40 to 49

  years and from 49\% to 58\% among women aged 50 to 64 years. The

  biennial screening rate increased from 56\% to 66\% for women aged 40 to

  49 years and from 68\% to 73\% for women aged 50 to 64 years. Screening

  rates increased significantly (P < .0001) after the elimination of cost

  sharing and then declined slightly after changes to government screening

  guidelines in 2009. Younger women experienced greater increases in both

  annual screening (6.2\%) and biennial screening (5.6\%) after the

  elimination of cost sharing in comparison with older women (3.0\% and

  2.6\%, respectively). In a multivariate analysis, rural residence, lower

  population income, and lower population education were associated with

  modestly lower screening. CONCLUSIONS: In a national sample of

  predominantly rural working-age women, the elimination of cost sharing

  correlated with increased breast cancer screening. (C) 2017 American

  Cancer Society.'
affiliation: 'Peppercorn, J (Corresponding Author), Massachusetts Gen Hosp, Canc Survivorship
  Program, 55 Fruit St, Boston, MA 02114 USA.

  Peppercorn, Jeffrey; Horick, Nora; Rabin, Julia, Massachusetts Gen Hosp, Ctr Canc,
  Boston, MA USA.

  Houck, Kevin, Duke Univ, Med Ctr, Durham, NC USA.

  Villagra, Victor, Univ Connecticut, Hlth Ctr, Farmington, CT USA.

  Lyman, Gary H., Fred Hutchinson Canc Res Ctr, 1124 Columbia St, Seattle, WA 98104
  USA.

  Wheeler, Stephanie B., Univ N Carolina, Sch Global Publ Hlth, Chapel Hill, NC USA.'
author: Peppercorn, Jeffrey and Horick, Nora and Houck, Kevin and Rabin, Julia and
  Villagra, Victor and Lyman, Gary H. and Wheeler, Stephanie B.
author-email: jpeppercorn@mgh.harvard.edu
author_list:
- family: Peppercorn
  given: Jeffrey
- family: Horick
  given: Nora
- family: Houck
  given: Kevin
- family: Rabin
  given: Julia
- family: Villagra
  given: Victor
- family: Lyman
  given: Gary H.
- family: Wheeler
  given: Stephanie B.
da: '2023-09-28'
doi: 10.1002/cncr.30629
eissn: 1097-0142
files: []
issn: 0008-543X
journal: CANCER
keywords: 'access to care; breast cancer screening; disparities; health policy;

  rural health'
keywords-plus: UNITED-STATES; TRENDS; RATES
language: English
month: JUL 1
number: '13'
number-of-cited-references: '26'
orcid-numbers: 'Lyman, Gary H/0000-0002-0823-8086

  Horick, Nora/0000-0002-4355-5853'
pages: 2506-2515
papis_id: 5b79a2f7a6bba0c650096f49e1837175
ref: Peppercorn2017impactelimination
researcherid-numbers: 'Peppercorn, Jeffrey/GPX-3100-2022

  Lyman, Gary H/K-5227-2019

  '
times-cited: '8'
title: 'Impact of the Elimination of Cost Sharing for Mammographic Breast Cancer Screening
  Among Rural US Women: A Natural Experiment'
type: Article
unique-id: WOS:000403469500019
usage-count-last-180-days: '0'
usage-count-since-2013: '4'
volume: '123'
web-of-science-categories: Oncology
year: '2017'