Connecticut has the second-highest incidence of breast cancer in the country, but is among the lower third of states when it comes to breast cancer deaths, according to a report released Monday by the Connecticut affiliate of Susan G. Komen for the Cure, a breast cancer advocacy organization.

To give a picture of breast cancer in Connecticut, the report included publicly reported health data as well as the results of interviews with patients and interviews and surveys of health care providers.

The report identified 39 “target towns” that have high rates of breast cancer mortality and high proportions of late stage cancers. The communities on the list varied considerably; one was Hartford, where 31.6 people live in poverty, while another, Glastonbury, has a poverty rate of 1.9 percent.

Connecticut has many screening and early detection programs, the report noted, and a higher rate of mammography than the nation as a whole. Still, black and Hispanic women aged 40 and older are less likely than white women to have had a mammogram in the past two years.

The report identified barriers to breast health services–some financial, some not. Nearly all health care providers included in the study said that women with late-stage diagnoses tended to have “full lives,” “more pressing personal issues,” and a habit of putting themselves last, the report said.

It also noted that many providers observed changes in screening delays and insurance coverage after the recession began in 2008. They reported seeing patients with higher deductibles to pay before their insurance paid the bills, patients who delayed screenings and routine visits because of uncertainties related to coverage and other financial issues, as well as having patients who were close to losing coverage or had already lost it.

The providers also identified barriers that prevented discussions with patients about breast cancer screening. Those included familial responsibilities, being unable to take time off from work, fear of knowing one’s cancer status and unfamiliarity with screening and preventive care. Providers also reported that language barriers could pose a problem, identifying a need for written materials and in-person interpretation for Spanish, Creole, Portuguese and Asian languages.

The providers said that uninsured women and undocumented immigrants were the least able to access breast cancer services and care, but they also identified rural residents, legal immigrants, minorities and the underinsured as underserved.

Many providers reported that they believed the Connecticut Breast and Cervical Cancer Early Detection Program, which is meant to improve access to screening and diagnosis for low-income women, was being underused. Providers said information about the program was poorly disseminated or poorly understood by women and general practitioners.

Arielle Levin Becker covered health care for The Connecticut Mirror. She previously worked for The Hartford Courant, most recently as its health reporter, and has also covered small towns, courts and education in Connecticut and New Jersey. She was a finalist in 2009 for the prestigious Livingston Award for Young Journalists, a recipient of a Knight Science Journalism Fellowship and the third-place winner in 2013 for an in-depth piece on caregivers from the National Association of Health Journalists. She is a 2004 graduate of Yale University.

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