Meeting the cancer screening needs of uninsured women in Georgia

William (Bill) J. Todd
President, Georgia Cancer Coalition

June 24, 2010

Re: Meeting the cancer screening needs of uninsured women in Georgia

Dear Mr. Todd: I run a non-profit women’s health care clinic in Rome, GA. We started this clinic because of the poor accessibility and affordability of gynecological preventative cancer care in Georgia. I believe we need to form a coalition to specifically address women’s preventative health care in Georgia. Thus, I am copying several others whom I know are involved with women’s health care issues in the hopes that we can generate some discussion or convene a meeting to discuss these issues for our women. Specifically, some of the problems I see are:

1. Uninsured women in our health district are currently being overcharged for Pap Smears by our public health departments and they are not being informed that fees can be scaled down. Consequently, many women who are at highest risk for cervical cancer are not getting screened at all. I have seen many women at our Rome clinic who have not had a Pap smear since I delivered their baby more than twenty years ago. They tell me that they have called their county health department and the price is well over $100 dollars. Many women do not know to ask for discounts and do not know that the health department cannot deny services to them if they cannot pay.

2. Further, if a woman receives a diagnosis of an abnormal Pap smear, it is virtually impossible for her to obtain diagnostic services. As you may know, a woman with an abnormal Pap does not qualify for any Medicaid assistance in Georgia until she is diagnosed with a high-grade abnormality that requires treatment. But the colposcopy to get that diagnosis can be several hundred dollars plus pathology fees, making diagnosis impossible. My impression is that the situation in Georgia is worse than that in Ontario where a recent study showed that less than 50 per cent of women who had a Pap with a low-grade abnormality have appropriate follow-up care. We have women come to our Rome clinic now from Atlanta because they cannot find an affordable colposcopy in their area, but we have no financial assistance to help these women pay for their biopsies. We need to compile a list of affordable colposcopy resources and set up a referral system for uninsured Georgia women who need, but cannot afford, diagnostic testing.

3. Even more worrisome, our health departments are now selectively screening out our highest risk women. We have had many calls from women telling us that public health refused to make them an appointment if they had a history of an abnormal Pap smear, because they are ‘too high risk.’ To confirm what patients were telling us, we had our clinic volunteers make calls and the H.D. in Gordon County refused to make an appointment for our caller. They required that she get a copy of her prior medical records and deliver it to them to review the records and then they would call her to let her know if she was eligible to make a Pap smear appointment there at all.

4. Women who are at risk for endometrial cancer have no access to affordable diagnostic services, either for endometrial biopsies or imaging services. I have seen many women in our Rome clinic who have been in and out of our local E.R.s with vaginal bleeding and similar symptoms suggestive of endometrial and cervical cancers. They are referred to local gynecologists, but seldom can uninsured women afford the cost of an office visit, much less diagnostic services. Their lack of affordable follow-up care delays their diagnosis and increases the indigent care costs of our hospital systems.

In Rome, we plan to continue to meet to discuss these issues and work on solutions. Unfortunately, the lack of preventative cancer screening disproportionately affects our low-income and minority women. I believe we need to form a Coalition to specifically address the problems of women’s preventative cancer screening in Georgia and to educate women about the importance of regular screenings. We also need a Women’s Advocacy Office to educate both women and health care providers, to provide referrals for women and to monitor compliance within our existing agencies. We would appreciate any assistance that the Georgia Cancer Coalition can provide.
Sincerely,
Marilyn

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Marilyn Ringstaff, CNM, JD
Women of W.O.R.T.H., Inc.
1513 Dean St.
Rome, GA 30161
706)232-3408 office
(706)512-0453 cell
mtringstaff@gmail.com
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