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

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

The introduction of digital mammograms has helped make finding certain breast cancers easier, even in dense breasts. But at $400,000, digital mammography is expensive, and the FDA estimates that the new screening technology is only offered at 20 percent of breast-imaging facilities in the United States.

For now, breast cancer survivor Becky Olson recommends that we keep our expectations in check. "Is it an exact science? No. Is mammography still the best screening tool we have for breast cancer? I believe it is."

Number of Women Getting Screened in Decline

Early detection of breast cancer has saved lives, but a National Cancer Institute study published last year showed a decline in the number of women getting screened, and that has radiologists and oncologists worried.

The fear is that women who put off getting their mammograms might be diagnosed with later-stage breast cancer, making them much more difficult to treat. The reasons women are backing off of routine screening aren't yet known, but long wait times could be partly to blame.

According to the NCI study, "It could be the end result of a cascade of events -- cost-cutting by insurers leading to lower reimbursements for doctors who perform mammograms, leading to fewer doctors getting specialized in reading the tests, leading to less availability and longer appointment delays for the patient."

It is widely accepted that delays in routine screenings can have serious consequences.

"You're putting yourself a greater risk the longer the interval between mammograms," according to Dr. Carl D'Orsi, director of breast imaging at Emory University in Atlanta. "Let's say you have to wait six months for an appointment, six months later than your last annual, you could lose six months of early detection if you have a fast-growing tumor."

Olson, who heads up a cancer support group in Oregon called Breast Friends, knows just how fast some cancers can grow. In August 2003, she got the all clear after having her annual screening. Ten months later, while doing a self-exam in the shower, she found a large, deep lump. It was stage-three breast cancer. "Some tumors are very fast-growing," she says. Even without delays, "There are 12 months between mammograms. ... A lot can happen in 12 months."  Or even 10.

But access does not show any sign of improving around the country. According to the Institute of Medicine, "the problem is that radiologists choose other fields. If there are not enough radiologists to do all the work available, which work would you choose to do? Would you choose a field in which professional liability is high, reimbursement is low and regulation is significant, or would you choose something else?"

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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