Breast, Cervical, and Colorectal Cancer Screening: Patterns Among Women With Medicaid and Commercial Insurance

Am J Prev Med. 2019 Sep;57(3):394-402. doi: 10.1016/j.amepre.2019.04.010. Epub 2019 Aug 1.


Introduction: Despite healthcare reforms mandating expanded insurance coverage and reduced out-of-pocket costs for preventive care, cancer screening rates remain relatively static. No study has measured cancer screening rates for multiple tests among non-Medicare patients.

Methods: This retrospective, population-based claims analysis, conducted in 2016-2017, of commercially insured and Medicaid-insured women aged 30-59 years enrolled in IBM MarketScan Commercial and Medicaid Databases (containing approximately 90 and 17 million enrollees, respectively) during 2010-2015 describes screening rates for breast, cervical, and colorectal cancer. Key outcomes were (1) proportion screened for breast, cervical, and colorectal cancer among the age-eligible population compared with accepted age-based recommendations and (2) proportion with longer-than-recommended intervals between tests.

Results: One half (54.7%) of commercially insured women aged 40-59 years (n=1,538,444) were screened three or more times during the 6-year study period for breast cancer; for Medicaid-insured women (n=78,897), the rates were lower (23.7%). One third (43.4%) of commercially insured and two thirds (68.9%) of Medicaid-insured women had a >2.5-year gap between mammograms. Among women aged 30-59 years, 59.3% of commercially insured women and 31.4% of Medicaid-insured women received two or more Pap tests. The proportion of patients with a >3.5-year gap between Pap tests was 33.9% (commercially insured) and 57.1% (Medicaid-insured). Among women aged 50-59 years, 63.3% of commercially insured women and 47.2% of Medicaid-insured women were screened at least one time for colorectal cancer. Almost all women aged 30-59 years (commercially insured, 99.1%; Medicaid-insured, 98.9%) had at least one healthcare encounter.

Conclusions: Breast and cervical cancer screenings remain underutilized among both commercially insured and Medicaid-insured populations, with lower rates among the Medicaid-insured population. However, almost all women had at least one healthcare encounter, suggesting opportunities for better coordinated care.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Breast Neoplasms / diagnosis
  • Breast Neoplasms / economics
  • Breast Neoplasms / prevention & control*
  • Colorectal Neoplasms / diagnosis
  • Colorectal Neoplasms / economics
  • Colorectal Neoplasms / prevention & control*
  • Early Detection of Cancer / economics
  • Early Detection of Cancer / standards
  • Early Detection of Cancer / statistics & numerical data
  • Female
  • For-Profit Insurance Plans / economics
  • For-Profit Insurance Plans / legislation & jurisprudence
  • For-Profit Insurance Plans / standards
  • For-Profit Insurance Plans / statistics & numerical data
  • Health Expenditures / statistics & numerical data
  • Humans
  • Mass Screening / economics
  • Mass Screening / standards
  • Mass Screening / statistics & numerical data*
  • Medicaid / economics
  • Medicaid / legislation & jurisprudence
  • Medicaid / standards
  • Medicaid / statistics & numerical data
  • Middle Aged
  • Patient Acceptance of Health Care / statistics & numerical data*
  • Patient Protection and Affordable Care Act / economics
  • Patient Protection and Affordable Care Act / legislation & jurisprudence
  • Practice Guidelines as Topic
  • Retrospective Studies
  • United States
  • Uterine Cervical Neoplasms / diagnosis
  • Uterine Cervical Neoplasms / economics
  • Uterine Cervical Neoplasms / prevention & control*