Why It Can Take a Year to Get a Mammogram in the U.S.

By Abby Christopher, AlterNet. Posted December 4, 2008.

Depending on where you live, the wait to get a routine breast screening could be as long as a year. And even if you're not facing delays today, if current trends continue, you might well be in the near future.

In Los Angeles, a routine mammogram appointment might not be available for four months; some medical clinics in New York City cite nine-month wait times; in Florida, delays are consistently six to nine months; and in parts of Rhode Island, you can expect to wait a year.

Why? Because many radiologists don't want to read mammograms.

"There is no public or private agency measuring or ensuring that women have reliable access to mammograms," says Robert Smith, Ph.D., director of cancer screening for the American Cancer Society.

While it's tough to pin down hard numbers -- how many radiologists read mammograms, the number of cases they read every week and where they practice -- one point that everyone, from radiologists to researchers, can agree on is that supply simply isn't meeting the growing demand for mammograms, as baby boomers age and 1.2 million women hit 40 every year.

Most radiologists don't choose mammography as a subspecialty for a number of reasons -- the repetitive nature of the job, narrow focus, the stress of missing a diagnosis -- but two are cited most often: money loss and malpractice.

"Missed or delayed diagnosis of breast cancer remains the leading cause of medical malpractice litigation in the nation today, while at the same time reimbursement for mammographic examinations remains embarrassingly low,"  explains Dr. Leonard Berlin, chairman of the department of radiology at Rush North Shore Medical Center in Skokie, Ill., and Rush Medical College in Chicago.

The shortage of breast-imaging specialists has forced general practice radiologists eager to avoid mammography to read routine screenings. Most practices rely on contracts with hospitals and physician-referral networks that, in many cases, require practices to offer mammograms. Some radiologists may be lured into mammography by various incentives offered to the practitioner who reads the most screenings. But more often, practices simply divvy up mammogram readings among staff.

"Junior staff get assigned to read mammograms, and most of them just don't want to do it. Most will try to cycle out and pursue other subspecialties like MR (magnetic resonance) and CT (computerized tomography)," says Dr. Barbara Sharp, an advocate for improved access and a breast-imaging specialist at Mori, Bean & Brooks Radiology, a general radiology practice in Jacksonville, Fla.

Cost of Mammography & Radiology

Many radiologists consider it bad business to offer routine breast screenings.

The number of facilities offering mammograms has dropped from 9,114 in 2004 to 8,832 in 2006, according to the FDA. Last year's Government Accountability Office report on mammogram access stated that "mammography facility officials most often cited financial considerations as the reason their facility closed."

Among the general practice facilities that do make mammography available (often to fulfill contractual obligations), many are reducing the number of appointments offered, favoring other imaging services that bring in more revenue.

"Mammography is a loss-leader. Right now, mammography is being subsidized by other examinations," said Dr. Ellen Mendelson, director of breast imaging and professor of radiology at Northwestern University in Chicago

In 2007, President Bush signed a hastily drafted cost-cutting measure called the Deficit Reduction Act, which cut Medicare reimbursements for MRIs and CT scans by as much as 40 percent, making it even harder for practices to absorb the losses mammograms generate since other imaging services are starting to bring in less money.

Because Medicare reimbursement rates are dropping for all imaging services, radiology practices are more inclined to cut back on or eliminate mammography, the service that brings in the least revenue. Medicare reimburses about $84 per screening mammogram, while the average cost to a facility for a mammogram is $125, according to a report on mammogram access published in July by Rep. Anthony Weiner (D-NY).

See more stories tagged with: health, breast cancer, medical malpractice, mammograms, breast cancer detection

Abby Christopher is a freelance health and health policy writer based in Portland, Oregon.

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