Mammogram: Two-Tier Fees, Greater Access

There's good news for Los Angeles women: More facilities now use a two-tier fee system, which recognizes that there's a difference in the kind of breast cancer exams they may require, UCLA researchers report.

Rather than charging all patients the more prohibitive fees for "diagnostic mammograms"--elaborate breast X-rays and exams normally administered only when cancer's presence is suspected--more facilities between January, 1986, and July, 1988, adopted lower charges for less-extensive "screening" or "preventive mammography."

"There has been an increase from 3.4% to 24.1% in the number of L.A. facilities that differentiate (in fees for) screening and diagnostic mammograms," said Dr. Lawrence W. Bassett, a UCLA radiological sciences professor and director of the Iris Cantor Center for Breast Imaging. He surveyed 55 facilities with Dr. Richard Gold, a UCLA radiological sciences professor.

They found that many centers at which both procedures are done charge only $50-$80 for screening mammograms, compared with the $130-$200 charged at centers where only diagnostic mammograms are administered.

Lower fees, Bassett and other radiologists hope, may encourage more women to follow the American Cancer Society and American College of Radiology breast cancer screening recommendations.

They now advise women to obtain a baseline mammogram between ages 35 and 40; undergo mammograms every one or two years from age 40-49; and have annual mammograms after age 50, spokeswomen said.

Cost a Factor

But "surveys show that only about 40% of all women over age 35 have had at least one mammogram," Gold said, adding that the procedure's cost has been a factor that prevented more women from having it done as reguarly as recommended.

A screening mammogram, however, can be performed at lower cost because it takes less clinician time than does a diagnostic mammogram.

A preventive exam "can be done effectively with two views of each breast," Bassett explained. "It's not generally necessary for the radiologist to take additional views or to do ultrasound or a physical exam."

A diagnostic exam, however, usually requires at least three views of the abnormal breast; special views, physical exams and ultrasound exams also may be ordered, Bassett said.

There's more good news: "Increasing numbers of insurance companies are covering screening mammograms," said Bassett, who presented his survey findings at a recent radiology meeting.

Consumers must check around to find facilities with the two-tier fee scales, Gold said. But Bassett noted that finding high-quality mammography facilities soon may become easier because the American College of Radiology is developing a mammography accreditation program.

Gender, Health Habits

Men are woefully behind women when it comes to most good health habits, a Louis Harris and Associates poll commissioned by Men's Health magazine shows.

The nationwide survey of 1,250 adults found that women were more likely than men to limit dietary salt and fat, to consume adequate fiber, to cut down on cholesterol-containing foods, to consume adequate vitamins and minerals and to limit sugary foods. Women are slightly more likely not to smoke and more likely to limit their alcohol and control stress.

The pollsters found that men are more likely than women to get regular, strenuous exercise; 43% of men reported getting regular exercise, compared with 27% of the women.

These results may reflect "sociocultural stereotypes still at work," said Dr. Lance Steinberg, a Los Angeles psychiatrist. Women's good health habits, centering on sensible nutrition, may reflect their "traditional nurturing roles."

Still, he believes that individual motivation, not gender, is the most important factor in improving health habits.

Back Brace for Scoliosis

New, bendable back braces that are worn only at night rather than round the clock may help patients better follow the therapy regimen for scoliosis, an abnormal curvature of the spine often diagnosed in the appearance-conscious preteen years.

In the last three years, at least two models of night-only braces have debuted, said Dr. Saul Bernstein, an orthopedic surgeon who directs the Scoliosis Center at Valley Presbyterian Hospital, Van Nuys, and is a USC clinical orthopedics professor.

Traditional braces now must be worn for as many as 23 hours a day, he explained, adding that studies show many patients don't follow their prescribed schedule.

All types of back braces work on the same premise: that by bending the torso in an opposite direction from the existing spinal curve will prevent it from worsening and sometimes improve it, as patients mature. Bracing is usually considered if the curve exceeds 20 degrees and bone growth is incomplete, Bernstein said.

The new braces, which are considered experimental and lack long-term patient follow-up, aren't for everyone, he said, adding that he believes the best candidates are those "under age 12 who have not completed their (bone) growth and have a single curve affecting the thoracic-lumbar (middle and lower back) or lumbar area."

Dr. John King, a USC clinical associate professor of orthopedics and a staffer at the Childrens Hospital of Los Angeles scoliosis clinic, observed: "Some people would have you believe this (new brace) works better than any other brace and that's not true." It's best, he believes, for single lumbar or thoracic curves of less than 35 degrees.

Some patients say the night braces are "harder to get used to" than traditional models, added Dr. John Brown, a Fountain Valley orthopedic surgeon and USC clinical associate professor of orthopedic surgery.

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