For Breast Cancer Awareness Month, we are using the Center for Improving Value in Health Care’s (CIVHC) Community Dashboard, powered by data from the Colorado All Payer Claims Database (CO APCD), to look at breast cancer screening rates in Colorado.
Breast cancer is one of the most common types of cancer in the United States, with over 280,000 new cases expected this year. However, the death rate of people with breast cancer continues to go down as screenings rise and improved treatment options lead to earlier diagnoses and interventions. According to data from the National Cancer Institute, Colorado follows the same trends as the nation. Breast cancer diagnoses across the state increased from 124 per 100,000 residents in 2010 to 130 in 2018. Meanwhile, the mortality rate dropped from 20 to 17.7 per 100,000 residents over the same time period.
Breast Cancer Screening Trends in Colorado
Breast cancer screening rates are one of the quality measures featured in the Community Dashboard and are based on Healthcare Effectiveness Data and Information Set (HEDIS) measures endorsed by the National Quality Forum. The HEDIS breast cancer measure assesses the percent of women ages 50-74 who have had at least one mammogram within the past two years.
Across all payers, breast cancer screenings in Colorado increased by 8.8% in Colorado from 2014-2019.
Along with improved overall statewide rates, breast cancer screening rates have continually improved among Colorado’s rural communities, growing from 55% to 58% from 2014 to 2019. However, when looking deeper at the data, disparities do appear between people living in urban and rural areas and by different health insurance types in those regions.
Before looking further at the divide in breast cancer screenings between Coloradans in rural and urban areas, it is important to highlight a specific subgroup which experiences drastically lower screening rates across the state. Among people covered by Medicaid, while there is less disparity in screening rates between urban and rural residents, overall screening rates are substantially lower than the statewide average and the other payer groups with less than 50% being screened.
Though there has been consistent improvement, screenings remain notably lower among people living in rural verses urban areas. One potential driving factor is limited access to providers and imaging facilities in rural areas.
The county map below shows that several rural counties in Colorado have very low rates of breast cancer screening – with many having fewer than 50% of women in the county receiving screenings as recommended. The counties with the highest rates of breast cancer screening tend to fall in the urban I-25 corridor and western slope areas, although there are some rural counties with higher screening rates such as Pitkin and Eagle which tend to be more affluent.
Breast Cancer Screenings by Health Insurance Type in Rural Communities
People living in rural areas covered by commercial health insurance are most successfully closing the gap between urban and rural screening rates with only a four percent lower rate in rural vs. urban areas.
Conversely, Medicare Advantage members exhibit the most pronounced difference in utilization based on geographic location. In 2014, rates for rural and urban were virtually the same at roughly 50%, but in 2019, 74% of urban residents with Medicare Advantage received a screening compared to only 57% of those living in a rural area.
In general, breast cancer screenings continue to improve across our state, however, the data shows that health equity gaps remain and opportunities to improve exist. CO APCD data, like that available on the Community Dashboard, can help Change Agents in Colorado boost breast cancer screening rates in many ways, including:
- Knowledge about regional variation in screening utilization can inform where to launch education and outreach initiatives.
- Demographic and information surrounding breast cancer screening based on payer type could provide insight into different barriers to access.
CIVHC will continue to track the state’s progress in breast cancer screenings and other quality measures with the Community Dashboard.
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