It has long been known that Connecticut has higher incidence rates of breast cancer in women and men than most of the nation. But perhaps even more surprising is the fact that in Fairfield County, barriers to preventative care and late-stage treatment persist for those lacking insurance.
“Even in this day of the Affordable Health Care Act we still have patients who are uninsured ”“ patients who can”™t afford to pay their deductibles or premiums or even their co-pays,” said Mark Melendez, a plastic and reconstructive surgeon with offices in Fairfield, Shelton and Greenwich.
Melendez, also a member of the Connecticut board of directors for the Susan G. Komen Foundation ”“ the largest organization dedicated to ridding breast cancer ”“ recently presented findings from Komen”™s “2015 Community Profile: An Assessment of Breast Cancer in Connecticut,” at a press conference at the state capitol in Hartford on Feb. 29. The study detailed not only the state”™s unusual high rates of breast cancer, but also the socioeconomic factors that skew treatment and access.
“We can say we are among the top five states in the United States with a high incidence of breast cancer,” Melendez said.
According to the Centers for Disease Control and Prevention, in 2012 Connecticut ranked fifth in the nation for incidence rates of breast cancer at 136 per 100,000. This rate was only slightly less than Massachusetts and Washington with 137 cases per 100,000 and closely trailing the most breast cancer ridden states of Hawaii and South Dakota with 140 and 141 cases per 100,000, respectively.
From 2008 to 2012, Fairfield County had the most cases of breast cancer throughout the state with New Haven County closely behind. No other county in the state came close to the incidence rates of the two counties, according to the U.S. National Cancer Institute.
“The first question people ask is ”˜Why?”™” Melendez said.
Lisa McCooey, director of the comprehensive cancer program under the Department of Public Health, said the answer is not easy to determine.
Both McCooey and Melendez point to Fairfield County”™s high population density and wealth as possible contributing factors.
“Fairfield County is a wealthier part of the state,” McCooey said. “People tend to have health insurance because they have jobs and those people tend to avail themselves of screening opportunities.”
This is further compounded by the relatively high density of health care providers in the county, she said.
But the causes of breast cancer are numerous, Melendez said.
“It is not just age and family history, but it could be environmental and it could be genetic,” he said.
Studies have been done to find possible connections between industrial production and nuclear power plants, but none have been able to identify a link, Melendez said.
“Environmental concerns are always a possibility,” McCooey said. “We just don”™t know enough about it, there is no cause and effect.”
McCooey said that other factors peculiar to Fairfield might also play a role in the high-incidence rates.
“Women of higher socioeconomic status tend to have children at later ages and a risk factor for breast cancer is not having children at all or waiting until after 30 to have your first child,” she said.
Both Melendez and McCooey cite findings in the study that indicate with greater access to health care comes more detection of breast cancer, but that this access is not evenly distributed throughout the county.
“Connecticut is home to immense diversity and with it, immense disparity,” Komen”™s community profile states. “Evidence suggests that while white women were far more likely to be diagnosed with breast cancer, Black/African-American women were significantly more likely to die from breast cancer if diagnosed. Such increased death may be related to higher late-stage diagnosis amongst Black/African-American and Hispanic/Latina women.”
The study and its participants identified several barriers to screening and treatment, such as limited transportation options, the need for translation services, inadequate insurance, lack of breast health education and busy work schedules. The study found that the most common theme among all focus groups was that the lack of insurance prevented many women from accessing routine screenings.
According to the study, most participants were uninformed about programs that offered free and low cost breast cancer screenings to uninsured and underinsured women. Women reported accessing the free and low-cost screening programs well after they noticed a symptom that they interpreted as being cancerous. In Fairfield and Litchfield counties, women reported having a concern about their breast health and neglecting it due to lack of insurance to access services.
Taking time off from work was also a major concern for women when considering when they can obtain health screenings. Women in Fairfield, Litchfield and New London Counties expressed their primary concern was requesting the time off from work. If sick days were available, they were considered best used for when they were sick and not for early detection screening. Getting screened was not perceived as a measure to detect cancer early.
“The backbone of the failure to provide access is education,” Melendez said.
The Komen Foundation agrees and listed several objectives in its 2016 action plan centered on increasing education and awareness, particularly among minority and underserved residents.
McCooey said from a state level, increased engagement with underserved communities can be achieved though measures such as increasing the number of mobile mammography vehicles that can bring screening directly to underserved communities.
The community profile found that while the Affordable Care Act has made health care more accessible and affordable for greater portions of the population than before, many Connecticut residents prioritize covering the cost of basic needs over health insurance.
“What we want to do from a state level is to go and try to find the women who are not currently engaged in the health care system,” she said.
Melendez adds that there are also structural challenges that are further impeding treatment, particularly within his field of medicine.
Melendez said there are very few plastic surgeons who will provide service strictly to Medicare and Medicaid patients due to the low reimbursement rates.
“As much as we want to be altruistic and heartfelt in what we do, there has to be some type of guideline,” he said. “You can”™t fill your whole practice with Medicare and Medicaid patients. I am probably one of the few plastic surgeons to take Medicare and Medicaid. I am doing this because I have given half of my life, literally, to do what I do. It is not driven by financial gain, but in the long term I do have to pay the bills and take care of my family.”
