Mammography Centers Cannot Keep Up with Demand

Chicago- Mammography centers are scaling back or even closing because of inadequate reimbursement rates and malpractice fears at a time when more and more aging baby boomers need annual breast exams.

It all adds up to a crisis taking shape in mammography, experts warned Wednesday.

With access shrinking, women often have to wait months to schedule an annual breast cancer screening and may decide to skip the exams altogether. Even women with suspicious lumps may have to wait several weeks to get a mammogram.

That can delay the diagnosis of breast cancer and result in tumors being detected at later, less treatable stages, a panel of doctors said at the Radiology Society of North America's annual meeting.

Studies have shown that routine mammograms can decrease the risk of dying from breast cancer by as much as 40%. About 1 million women a year are turning 40, the age when many doctors say annual screening should begin, the panel said.

Screening mammograms typically cost between $75 and $150, while diagnostic mammograms, performed when a problem is suspected, may cost well over $200.

Recommended Medicare reimbursement rates, set by Congress, are well below that - $67 for a screening mammogram and $81 for a diagnostic exam, said Dr. Stephen Feig, director of breast imaging at Mount Sinai Medical Center in New York.

That cuts into the budgets at many mammography centers, which are being subsidized by their other radiology services, said Dr. Ellen Mendelson, director of a breast imaging center at Western Pennsylvania Hospital.

The most prominent closure occurred last year when New York University Medical Center shut one of its two mammography services for financial reasons. A few smaller centers elsewhere have closed, and many others have reduced services, the panel said.

Lagging reimbursement rates and concerns over malpractice - the exams miss between 10% and 20% of cancers - are leading many would-be mammographers to choose other specialties, the panel added.

''The people required to deliver the service aren't going into the field,'' said Dr.Dieter Enzmann, radiology chairman at Northwestern University.

At NYU Medical Center, for example, applications for a mammography fellowship fell 75% last year, said Dr. Gillian Newstead, NYU's director of breast imaging.

The result will probably be reduced services, longer waits and potentially more cancers detected at less treatable stages, the panel said.

The American College of Radiology, in a May letter to the federal government's Health Care Financing Administration, warned that more hospitals may scale back mammography services unless reimbursement rates are increased.

The American Association of Health Plans, however, doesn't see a crisis looming.

The AAHP, which represents more than 1,000 managed care plans and other insurers, cites national figures showing that the number of women aged 40 and older who have had a mammogram within the last two years more than doubled since 1987. Such figures, the group said, do not suggest any lack of access.

''The data we have available doesn't support a crisis in mammography,'' said Dr. Charles Cutler, the group's chief medical officer. ''The plans in general have been increasing reimbursement rates over the last few years.''

While some centers may have closed, the overall number has hovered at around 10,000 nationwide for the past few years, said AAHP spokeswoman Susan Pisano.