What would motivate Utah women to get mammograms?
Would pairing a breast exam with a spa treatment dubbed a "mammy-pedi" get more Utah women to get a mammogram?
Or having employers encourage the screening by offering time off work?
The Utah Health Department collected these ideas and more Thursday at a Salt Lake City summit aimed at raising Utah's near-rock-bottom mammogram rates.
It invited radiologists, cancer specialists, physicians and survivors along with employees of health insurance companies and hospitals to brainstorm new ways to reach out to women.
Lynne Nilson, breast and cervical cancer program manager for the department's Cancer Control Program, said Utah women have the second-lowest mammography rate in the country.
A 2010 report from the Centers for Disease Control and Prevention showed that 67 percent of Utah women had had a mammogram in the past two years. The national rate in that span was 75 percent.
The top reason women gave for not getting screened, 33 percent, was because they didn't have time or they were "lazy," according to Health Department data.
About a quarter of women reported they didn't get screened because of the cost or they didn't have insurance. The Affordable Care Act requires health insurance plans to cover the screening at no cost to women. Still, Nilson said, the majority of Utah women who didn't get a mammogram in the past two years, 75 percent, had insurance.
"I don't know that it will bring the rates up," she said in an interview.
Nilson said it was time to get creative to motivate women. Some of the ideas the 50-or-so participants came up with included:
• Making mammograms more accessible by extending the hours for screenings, expanding mobile clinics, making the screenings child-friendly and creating special events to encourage large numbers of women to get screened.
• Offering more education. Women need to know what their health insurance covers and when they are due for a mammogram. Doctor's offices could call to see if women have made their mammogram appointments after their physician has recommended one. Women also should know they don't need a referral to get screened. And the Health Department could take on the role of telling women where to go.
• Involving various partners to urge women to get screened. That includes grocery stores, churches and employers to reach women outside of doctors' offices.
• Deciding on a universal screening message. Ever since the U.S. Preventive Services Task Force in 2009 recommended women delay mammograms until age 50, due to the risks of false positives, women have been confused about what to do, according to radiologists at the meeting. Other groups, including the American Cancer Society, continue to advise annual screening starting at age 40.
Arlen Jarrett, an obstetrician/gynecologist, said he saw screening rates rise at his office to nearly 100 percent when he made it more convenient by adding a mammography machine in his office.
But rates fell after the 2009 recommendations. "The message came across that it was bad," he said.
The Utah Health Department has had its own internal debate and settled on advising "routine" screening starting at age 40.
But many at the meeting want the state to advocate for annual screens.
Matthew Stein, section chief of breast imaging at the University of Utah's Huntsman Cancer Institute, said he and other radiologists around the state urge annual screenings.
And in case people think that recommendation is about money, he said his salary is not dependent on the number of mammograms performed.
The Health Department plans to tackle the topic of a universal message in January.
Breast cancer screening in Utah
Among commercially insured Utahns in 2010, women living in the Avenues and around the University of Utah had the highest rates of mammograms at 56 percent.
The state's lowest rates 36 percent and lower were largely found in rural Utah: Sevier, Piute, Wayne, Grand, Daggett, Duchesne, Uintah, Grand, San Juan, Juab, Millard, Sanpete and Tooele counties.
Other low-rate locations include the west side of Salt Lake City, Clearfield and Hill Air Force Base areas, southern parts of Utah County and Magna.
The state average in 2010 was 43 percent.
Source • "A snapshot of clinical performance by Utah small area," Utah Department of Health