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William J. Gradishar, MD, FACP, FASCO


Do High-Deductible Health Insurance Plans Influence Patients’ Decisions to Undergo Breast Cancer Screening?

By: Amy MacDonald, MS
Posted: Monday, May 22, 2023

Screening mammography is an important tool for breast cancer detection that has been shown to reduce breast cancer deaths. However, data suggest that even modest insurance copays may influence some womens’ decisions to complete yearly screening mammograms.

Priscilla J. Slanetz, MD, of Boston University Chobanian and Avedisian School of Medicine, and colleagues hypothesized that cost may drive nonadherence to follow-up breast cancer imaging in patients with high-deductible health insurance plans. Their data, published in the journal Radiology, revealed that the presence of deductibles for diagnostic breast imaging following an abnormal breast screening may, in fact, discourage women from returning for follow-up imaging.

The researchers distributed a paper questionnaire to all 6,110 patients who presented for breast imaging at a single institutional medical center from September 2021 to February 2022. A total of 844 patients elected to participate in the study and completed a sufficient number of responses to be evaluated. Of these 844 patients, 714 responded to the hypothetical statement, “If I knew I had to pay a deductible for the additional imaging (to make sure my screening mammogram was normal), I would skip this additional imaging.”

Study results revealed that 21.1% (151 patients) agreed they would skip imaging, 59.4% (424 patients) disagreed that they would skip imaging, and 19.5% (139 patients) were undecided. Of note, statistical significance was achieved when patient responses were additionally stratified according to the following factors: race, level of education, household income, and health insurance payer (P = .003, P = .001, P < .001, and P < .001, respectively). The study found that patients who might choose to delay their breast imaging care because of out-of-pocket insurance costs disproportionately identified as members of racial or ethnic minorities, came from lower-income brackets, had lower levels of education, were insured through Medicaid, or had no insurance at all.

Disclosure: For full disclosures of the study authors, visit

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