The purpose of this study was to identify personal, economic, and health care system barriers to mammography in a managed care population. Participants were Black and White female residents of Middle Tennessee, aged 40 years and older, who were members of a Medicaid-funded managed care organization and, according to claims data, were not current with mammography screening at least one year prior to study initiation. Twenty-one barriers were grouped into three categories - personal, economic, and health care system barriers. Trained interviewers recorded participant self-reported responses to barrier statements from 173 women (46% Black) through telephone or personal visits. The correlations of reported barriers to annual checkup, clinical breast exam, and mammogram screening were examined. The findings suggest that even among insured low-income women, significant barriers remain to breast cancer screening, particularly low rates of physician recommendation, lack of relevant information, and prevalence of mistrust and fear. Health care system changes can improve cancer prevention screening practice and would result in an increase in breast cancer screening rates among low-income insured and uninsured populations.
