Background: Low-income and uninsured women have lower odds of receiving age-appropriate cancer screens that can detect cancers earlier and reduce morbidity/mortality. A key question is whether federal/state public health programs aimed at increasing screening and other public policies (e.g., welfare reform, managed care) have affected their receipt of these preventive services.
Methods: Data from the Behavioral Risk Factor Surveillance System (BRFSS) were used to estimate the effects of public programs, income, and insurance status on the odds that women received mammography, clinical breast examination (CBE), or Papanicolaou (Pap) smears from 1996 to 2000. State fixed-effects models are estimated. Effects of the age (measured in years) of states' National Breast and Cervical Cancer Early Detection Programs (NBCCEDPs) and level of federal funding are presented.
Results: Adjusted odds of uninsured women reporting female cancer screens were lower than for those privately insured, and did not change between 1996 and 2000 despite welfare reform and increasing numbers of uninsured. The age of states' NBCCEDPs were associated with increased odds of mammography, CBE, and Pap smear screens for non-elderly women. For example, the aging of a state's program from 0 to 5 years was associated with an increase in the percentage of women receiving mammography from 52.7% to 55.1%.
Conclusions: Despite efforts to increase screening among low-income uninsured women, their average rates remain below those with higher incomes and/or insurance. However, initiation and maintenance of the states' NBCCEDPs over long periods is associated with increased screening. After accounting for program age, increased federal dollars are associated with slight increases in screening for women aged >65.