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Access to Mammography On the Decline

Study finds lack of radiologists, and problem may worsen

TUESDAY, April 26, 2005 (HealthDay News) -- Access to mammography may become a problem for American women if staffing shortages at screening centers continue, according to a new study.

While there are several reasons for the shortages, for women, the message is clear: Be sure to make your annual appointment in plenty of time, so the delay you may experience won't make the interval between screenings too long.

Researchers surveyed 45 mammography facilities in three states -- Colorado, New Hampshire, and Washington -- and found that 44 percent did not have enough radiologists on staff to meet the demand for mammography services.

"It was a surprise in terms of how broad the problem is," said study collaborator R. Edward Hendrick, a research professor and director of breast imaging research at Northwestern University and Northwestern Memorial Hospital in Chicago.

The waiting times are not yet "dreadful," but "we may have a crisis down the road in a few years if the trend continues," he added.

"What this survey showed is that the problem is really broader and occurs at a lot more sites than we had anticipated," Hendrick said.

The findings are published in the May issue of the journal Radiology.

Mammography, an X-ray of the breasts, is considered by many experts to be the most effective routine screening tool for detecting breast cancer in its earliest and most curable stages. This year, more than 211,000 women in the United States will learn they have breast cancer, and more than 40,000 will die from the disease, according to American Cancer Society estimates.

In the study, researchers led by Dr. Carl D'Orsi, professor of radiology and director of the Breast Imaging Center at Emory University in Atlanta, found that 85 percent of the 45 facilities surveyed reported being able to schedule diagnostic mammograms -- performed to settle a question related to a symptom or breast abnormality -- within one week of the request. But only 30 percent of the facilities had the ability to schedule screening mammograms -- performed on women without any symptoms as a preventive test to detect cancer early -- within a week.

About half, or 47 percent, of the centers said they had waits of two or more weeks for screening mammography. In the higher-volume facilities, the delays for both types of mammogram were two to three times higher than in the lower-volume centers. At some, the waiting times were up to four weeks, the investigators found.

The survey covered the years 2001-2002.

Part of the problem, said Hendrick, is mammography isn't well reimbursed by Medicare plans, and that insurance companies tend to follow suit.

Robert Smith, director of cancer screening for the American Cancer Society, said he and other experts have been hearing anecdotal reports of delays in screenings for some time, but this study documents the problem.

"A big part of [the problem] is economic," he said, referring to the reimbursement issues. And, he noted, many in radiology go into other imaging specialties besides mammography that they consider more challenging.

Women should be aware they may need to make an appointment earlier than they used to if they want to keep the one-year interval recommended between screenings, Smith added.

More information

To learn more about mammography, visit the American Cancer Society.

SOURCES: R. Edward Hendrick, Ph.D., research professor and director of breast imaging research at Northwestern University and Northwestern Memorial Hospital, Chicago; Robert Smith, Ph.D., director of cancer screening, American Cancer Society, Atlanta; May 2005, Radiology
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