Screening Mammography: Let's talk about accountability

The Association of American Physicians and Surgeons recently issued a release stating that “Women get better care in the US than in Canada or England.” http://www.aapsonline.org/newsoftheday/00123. The statement came as part of the lobby of the new Obama-Biden transition team, which ran on a platform of improving access to and costs of care in the US.

The release used just one statistic to make its point, comparing mammography rates in the US, at 71.8% of women aged 50 to 64, with the 51.8% rate in Canada where, they say “everyone is insured.” While this is hardly indicative of the health status of an entire nation, it does point out a glaring shortcoming in Canadian healthcare: screening and accountability.

One of the challenges with screening and prevention in Canada is that we don't provide unfettered access to screening tools such as PSA tests (men have to pay unless they have clinical indications or family history) and screening colonoscopies. In the US, government sponsored Medicare and Medicaid pay for screening colonoscopies every 5 years for EVERYONE on social assistance, after the age of 50. Some speculate that the higher screening rates in the US are as much to do with the insurance business as they are to do with good health literacy and patient accountability. Insurers often provide financial incentives for enrolled members to participate in screening programs because, they say, early intervention is less costly than a late diagnosis. OK, and it saves lives.

Every woman is entitled to a screening mammogram each year after the age of 40 under the BC Medical Services Plan. But while guaranteed access is one thing, patient accountability is another. There is demonstrable evidence that mammography, combined with physical exam, reduces the rate of mortality from breast cancer. Can it really be that 48% of Canadian females over the age of 50 can’t recognize this? Early detection will potentially save your life.

While we don’t provide access to all the screening tools that research suggests may be useful to early intervention, nor do we as Canadians, take responsibility for such screening and prevention tools. Booking a screening mammogram is as easy as calling 604 775-0022 to book your appointment in Vancouver, or visit http://www.bccancer.bc.ca/PPI/Screening/Breast/Screening+Mammography+Locations+and+Mobile+Services.htm#vancouver for other numbers and locations throughout BC.

If you are a woman over 40, and haven't taken advantage of access to mammograms, or over 50 (male or female) and haven't had your family doctor provide a fecal occult blood test as a colon cancer screening test (FOBT), you lack the responsibility and accountability for your own care. Good health requires your active participation, whether it is "free", or not.

Health Literacy

Research suggests that the single biggest indicator of health status of a society is its level of health literacy. Health literacy is defined as the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.

There is no shortage of academic study in the area of health literacy, with much of it focussed on literacy rates and why health literacy is important. There is an underwhelming amount of programs designed to address issues to improve health literacy among target populations.

I'm starting a new non-profit to deliver health literacy programs to specific populations in the Lower Mainland of British Columbia. Our strategy is to develop a speakers' bureau of subject experts, develop consistent and appropriate presentations and materials, and delivery seminars and talks to established groups and organizations of seniors, low income women, and youth.

If you have subject expertise, literacy subjects, or an established group that would benefit from the delivery of a health literacy program, please let us know.

Astrid