ASPPH logo


Member Research & Reports

Member Research & Reports

Georgia State: Easing Nurse Practitioner Rules Could Improve Access to Mammograms

Allowing nurse practitioners to provide primary care without restriction could increase breast cancer screening rates among underserved populations in the United States, including low-income and minority women, according to a recent study led by a researcher at the School of Public Health at Georgia State University.


[Photo: Dr. Lee Rivers Mobley]

The study noted previous research showing access to a primary care provider — whether a traditional medical doctor or a nurse practitioner (NP) — is a key factor in a woman’s motivation to seek mammography to screen for breast cancer.

This study found that women were less likely to get a mammogram if they lived in a state with a greater perceived shortage of primary care physicians. However, mammography use was consistently higher in six states where NPs are allowed to provide primary care without physician oversight, thus filling the void. (In this study, perceived primary care physician shortage was measured as the percentage of people in the state who perceived such a shortage, based on information obtained from the American Association of Retired Persons.)

“Findings from this study indicate that relaxing NP scope-of-practice laws may be a promising lever to increase mammography use rates among Medicaid-insured women across the urban-rural continuum,” the researchers concluded.

The study’s results are published in the Journal of Racial and Ethnic Health Disparities in an article titled “Breast Cancer Screening Among Women with Medicaid, 2006-2008: a Multilevel Analysis.” The study’s lead author is Dr. Lee Rivers Mobley, associate professor of health management & policy at the School of Public Health.

Researchers analyzed annual Medicaid claims and enrollment files of nearly 2.5 million women in 25 states from 2006 through 2008. Six of those states—Iowa, Montana, New Hampshire, New Mexico, Oregon and Wyoming — had unregulated nurse practitioners. The remaining 19 states — Arkansas, California, Georgia, Indiana, Kansas, Kentucky, Louisiana, Michigan, Minnesota, North Carolina, Nebraska, New Jersey, New York, Rhode Island, South Dakota, Tennessee, Texas, Virginia, and Vermont — regulated nurse practitioners. The women included in the study were Medicaid enrollees between the ages of 40 and 64 who had never previously been diagnosed with cancer.

“Nationally, about one third of women with breast cancer are diagnosed at a late stage (leading to greater morbidity and higher mortality) which might be reduced with greater utilization of breast cancer screening,” the study noted.

The study also found that the odds ratios for Black and American Indian women showed they were less likely to receive mammograms than White women with Medicaid insurance. Hispanic women showed higher rates of mammography use than White women with Medicaid insurance.

The study’s authors also include Dr. Sujha Subramanian, Sonja Hoover and Jiantong Wang with RTI International, and Dr. Florence K. Tangka, Dr. Ingrid J. Hall and Dr. Simple D. Singh with the Centers for Disease Control and Prevention’s Division of Cancer Prevention and Control.