As the economy falters and more people go without health insurance, low-income women in at least 20 states are being turned away or put on long waiting lists for free cancer screenings, according to the American Cancer Society's Cancer Action Network.

In the unofficial survey of programs for July 2008 through April 2009, the organization found that state budget strains are forcing some programs to reject people who would otherwise qualify for free mammograms and Pap smears. Just how many are turned away isn't known; in some cases, the women are screened through other programs or referred to different providers.

"I cried and I panicked," said Erin LaBarge, 47. This would have been her third straight year receiving a free mammogram through the screening program in St. Lawrence County. But the Norwood, N.Y., resident was told she couldn't get her free mammogram this year because there isn't enough money and she's not old enough.

New York used to screen women of all ages, but this year the budget crunch has forced them to focus on those considered at highest risk and exclude women under 50.

"It's a scary thought. It really is," said LaBarge, who fears she's at a higher risk because her grandmother died of breast cancer.

The Cancer Society doesn't have an estimate for what percentage of breast cancer diagnoses come from mammogram screenings, but says women have a 98 percent survival rate when breast cancer is caught early, during stage I. That shrinks to about 84 percent during stages II and III, and just 27 percent at stage IV — when cancer has reached its most advanced point.

"I already know there are women who are dying whose lives we could have saved with mammography and other detections," said Dr. Otis Brawley, chief medical officer for the society.

In New York, the Cancer Society says providers in Manhattan, Brooklyn and western Queens, and in Nassau, Suffolk and Westchester counties project they'll perform nearly 15,000 fewer free mammograms for the fiscal year ending April 2010, compared with the previous year.

The Cancer Society has no way to count how many women are being turned away, and many providers don't keep track of how many are denied screening, or whether those women find another alternative. The cost of screening varies, but the average mammogram is about $100, while a Pap screen can range between $75 and $200, according to the society.

Project Renewal Van Scan, which gives mammograms around New York City, usually targets 6,000 women a year but has cut back to 3,100 this year, director Mary Solomon said.

Each state handles free screenings differently. Some use state funds to supplement federal funding, while others get private assistance from the Susan G. Komen for the Cure foundation and other groups.

At least 14 states cut budgets for free cancer screenings this year: Colorado, Montana, Illinois, Alabama, Minnesota, Connecticut, South Carolina, Utah, Missouri, Washington, Ohio, Massachusetts, Pennsylvania and Arkansas.

Some states that have cut their budgets have found ways to maintain services; some states that haven't reduced their budgets still find themselves having to turn women away because they don't have enough funding.

"This is rationing of health care by offering (screenings) only in the first half of the fiscal year, or by cutting back on those programs," Brawley said. "It's rationing that is leading to people dying."

New York, which has fought for two years with deficits in the billions, used to screen women of all ages for breast cancer, but after $3.5 million in budget cuts this year, women under 50 — like LaBarge — are no longer eligible unless they have the breast cancer gene or a serious family cancer history. Despite LaBarge's family history, she was denied screening because of her age and a lack of funding.

"We don't do this lightly," said Claudia Hutton, spokeswoman for the agency. "This is not a cut that we would have made if the state had the money, but the state just does not have the money."

The issue of when women should get mammograms erupted into controversy last month when the U.S. Preventive Services Task Force recommended that the exams not be given routinely until women are 50, and then every two years.

That broke with the Cancer Society's long-standing position that women should begin getting mammograms at the age of 40 and annually thereafter; the American College of Obstetricians and Gynecologists recommends mammograms every one to two years for women in their 40s and every year after age 50.

The American Cancer Society opposes the federal task force recommendations.

"I think they made a mistake here," Brawley said.

In 2009, the Cancer Society estimates, 34,600 women between 40 and 49 will be found to have breast cancer nationwide; in that age group, 4,300 breast cancer deaths are projected this year.

Oregon, with 57,000 eligible women, now limits free screenings to 6,000 annually, said Amy Manchester Harris, manager of the Breast and Cervical Cancer Program. Many states, including Oregon, still screen women with symptoms, such as a breast lump.

"It's pretty painful" to turn women away, said Shari House, owner of the Pearl Health Center in Portland.

"They get angry, they get depressed, they get hopeless," she said. "It's like having a door slammed in your face."

Sarah Gudz, who directs the Ohio Department of Health's Breast and Cervical Cancer Project, said higher unemployment and more people without insurance has increased the pool of women seeking free screening.

Ohio allocated $2.5 million for 2008-09; state funding dropped to $700,000 for 2009-10. Last year Ohio served nearly 17,000 women, but the state is projected to fund 14,000 screenings in 2009-10.

The federal Centers for Disease Control and Prevention estimates that since 1991, the free screening program has provided more than 8 million exams to more than 3.4 million women, detecting more than 39,000 breast cancers, 2,400 invasive cervical cancers and 126,000 pre-malignant cervical lesions.

The American Cancer Society's Cancer Action Network says the economy has forced cutbacks in screenings at a time when more people are uninsured.

The society surveyed programs for July 2008 through April 2009 and found that state budget strains are forcing some programs to reject people who would otherwise qualify for free mammograms and Pap smears.

In some cases women are screened by other programs or referred to different providers.

New York used to screen women of all ages. This year's budget crunch has forced them to focus on those at highest risk and exclude women younger than 50.