Breast-test centers decline as need for them increases

Mammogram clinics find fees don't cover cost of procedure

October 28, 2001|By M. William Salganik | M. William Salganik,SUN STAFF

Saying they are losing money on each breast X-ray, some mammography centers are closing, and few new ones are opening, raising fears that women may encounter increasing difficulty getting screened.

A year ago, 167 Maryland facilities performed mammograms, but the number has dropped to 150, according to the American College of Radiology, the professional group that accredits mammography centers.

Nationally, the number of centers has slipped from 9,873 in March to 9,534 today , the American College of Radiology says.

Although Medicare payments for breast screening are due to rise 28 percent next year, those in the field say lower reimbursements from HMOs will continue to make mammography a losing business proposition.

In addition, the field has a shortage of technologists and radiologists specializing in mammography.

The closing of mammography centers is occurring at a time when the demand for mammograms is increasing as the population ages and more women heed the recommendation for annual screening beginning at age 40.

The number of women getting annual screenings has gone from about a third of those in the target age group to about two-thirds over the past decade, according to the American Cancer Society. There are about 64 million women over 40, according to the Census Bureau, and that number is projected to increase 28 percent over the next two decades.

"When we go to radiology meetings, we always talk about the crisis," said Dr. Judy Destouet, chief of mammography for Advanced Radiology. Advanced has dropped mammography service at five Baltimore area centers in the past four years but still has 16 centers in the region.

In an article in the March edition of the professional journal Seminars in Breast Disease, Destouet calculated that Advanced lost $7.82 on each Medicare mammogram in 1999, for a loss to the practice of $900,000.

The closing of mammography centers also has resulted in longer waiting times for patients.

Advanced Radiology reports a waiting period of about three months for a screening mammogram, compared with one to two months a few years ago.

Advanced and another large radiology practice, American Radiology, provide most of the mammography in the Baltimore area, either in their own radiology offices or at hospitals. American Radiology officials declined to comment for this article.

Johns Hopkins and University of Maryland Medical Center perform mammograms in their own radiology departments.

Johns Hopkins has four-week waits for screening, while "five or 10 years ago, you'd just walk in," said Dr. Laurie Fajardo, director of breast imaging.

Some studies show that longer waits can discourage women from getting annual screenings on schedule, said Dr. Gina Sager, a breast surgeon who practices at Franklin Square Hospital. And, doctors say, women are more likely to miss an appointment made months in advance. Sager also is afraid that delays in diagnosis could lead to more malpractice claims.

But there's no comprehensive source of data on waiting times or whether women are skipping exams.

"There's been a fair amount of hype about this problem, but we are lacking objective data," said Dr. Wendie Berg, director of breast imaging at the University of Maryland Medical Center.

Berg's own center, which opened a new facility with three mammography units in April, has only brief waits, compared with a four-month lag before the center opened.

"I don't think there is persuasive data that there is a crisis in access at this moment," said Dr. Robert Smith, director of cancer screening for the American Cancer Society. "But we could very soon find ourselves in the midst of a crisis where women can't get access to mammograms."

The problem, some say, is not so much centers shutting down as it is that new centers aren't opening fast enough to keep up with demand.

"You're not going to see massive closures. I can't close my mammography service and say to my referring physicians, `I'll do everything but mammography,'" said Dr. R. James Brenner, who runs a breast-imaging center in Los Angeles and is chair of the College of Radiology's task force on mammography practice.

"But there are disincentives to expand resources," Brenner added, "which translates into access and into whether people choose to specialize in this field. Ultimately, that may translate into missed cancers or unnecessary biopsies."

There are two types of mammograms: screening mammograms, which are done periodically to look for signs of breast cancer among women with no symptoms, and diagnostic mammograms, which offer more views of each breast.

The College of Radiology and the American Cancer Society recommend annual screening mammograms for women 40 and older. More extensive diagnostic mammograms are ordered when a screening mammogram or other symptoms suggest a possible problem.

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