Call for More Mammogram Providers Fuels Debate

A worsening shortage of providers is threatening access to mammograms, according to a new study that found long waits for breast X-rays in parts of the country.

Too many women avoid mammograms, yet the scans are the best method for detecting breast cancer when it’s most treatable, the Institute of Medicine said Thursday.

Improving access, through such steps as allowing trained nondoctors to help radiologists, is crucial to getting more women checked, concluded the scientific group, which advises the government on health issues.

“Mammography saves lives, and we need to figure out a way to get it to more patients, more uniformly,” said Dr. Etta Pisano, chief of breast imaging at the University of North Carolina at Chapel Hill, who co-wrote the report.

The American College of Radiology immediately criticized the idea of letting nondoctors, specially trained or not, play a role in reading mammograms.

“We should not lower the bar so that women have a perception of increased access, only to find that the access is to inferior care,” said Dr. James Borgstede of the radiology group, which is pushing for better mammogram reimbursement and other steps to increase the number of providers.

The debate comes at an important time.

The number of mammography facilities has dropped more than 8% since 2000, to 8,600 sites around the country. In parts of Florida, three-month waits are common, the report found. In New York City, the average wait for a first-time mammogram is more than 40 days.

Fewer radiologists are specializing in breast imaging because of long hours, low reimbursement, heavy regulation and fear of lawsuits.

The report said that about 60% of the women old enough for routine mammograms get them -- and every year, 1.2 million more women turn 40, the age when most are supposed to begin getting the tests.

Lack of insurance, no system for notifying women to get checked, and public confusion or fear about breast cancer detection all play a role in the problem, says the institute’s review.

For women who do seek mammograms, the closure of scanning centers suggests “a serious decline in access,” the report concluded.

Women have a one in 10 chance of a suspicious spot turning out to be noncancerous, nearly double the rate in the 1980s, the report found. That may be due partly to radiologists practicing “defensive medicine” in hopes of avoiding lawsuits -- but it leads to costly repeat testing and adds to women’s anxiety about mammograms.