With more women reaching the recommended age for routine mammograms, fewer clinics are offering the service.
By LISA GREENE
Published June 11, 2004
Women across Florida are having to wait up to several months for routine mammograms, a problem echoing across the country as the population ages and breast screening clinics shut down.
Those delays, along with the fact that millions of women have no health insurance, mean that 40 percent of women who should receive mammograms are not getting them, according to a report released Thursday by the Institute of Medicine and the National Research Council of the National Academies of Science.
The specialists who interpret mammograms face heavy regulation, fear of lawsuits and low reimbursement for long hours, said the report, which expands on a previous study by the two research centers.
"It's very much a dilemma right now, and it's going to get worse," said Dr. J. Daniel Stone, a partner in the Price, Hoffman, Stone & Associates radiology practice in St. Petersburg.
More than 200,000 new cases of breast cancer will be diagnosed this year, and more than 40,000 women will die from the disease. Mammograms correctly spot cancers 83 to 95 percent of the time, but up to 17 percent of tumors are missed during at least one exam.
Over the past three years, the waiting time to get a routine screening mammogram has increased from three to five days, to two months at his center, Stone said.
"The only way we've been able to keep it down to two months is to increase our hours," Stone said. "Without that, I'm sure we'd be looking at a four-month backlog."
Over the past 10 years, the number of screening clinics listed by the American Cancer Society has declined by 15 percent, while the number of women who should have mammograms has risen 32 percent, said Ray Carson, a vice president of the society's Florida division.
"Clearly, those two numbers collide," Carson said. "It's been rather dramatic."
Fourteen of Florida's 67 counties have no mammography centers, Carson said. The Legislature passed a law this year directing the Department of Health to study why so many clinics are closing.
In the Tampa Bay area, more mammography centers are available, and some larger facilities said waiting times aren't a problem. Bayfront Medical Center in St. Petersburg can schedule regular mammograms within a week. At Morton Plant Hospital in Clearwater, screening mammograms are scheduled "in a matter of days" and sometimes on the same day, said spokeswoman Beth Hardy.
Most places said that when a woman finds a lump in her breast, or doctors suspect cancer, clinics schedule diagnostic mammograms within a few days.
Still, screening mammograms are hard to schedule at many places. Many Tampa Bay area clinics have a wait of two to three months, said Reza Razavi, general counsel and director of operations at the Women's Diagnostic Center in Brandon. A year ago, the wait at his the women's center was three months, Razavi said. He has cut that to about six weeks and hopes to cut it to one month by expanding the center.
"More and more radiologists are not interested in focusing on mammography," Razavi said. "It's more profitable to do high-end radiology, CAT scans or MRIs."
At Largo Medical Center, the wait is about a month, said hospital spokeswoman Sandy Gourdine. It used to be shorter, but two years ago the nearby Diagnostic Clinic stopped doing mammograms, forcing about 18,000 women to go elsewhere. At the time, the clinic president cited rising costs, lawsuit fears and increased regulation as the reasons for the shutdown.
The report considers the promise of new technologies for increasing the accuracy of breast-cancer detection. But it concluded that even though mammograms are not perfect, they remain the best means for screening the general population to catch breast cancer at its earliest and most treatable stages.
"Improving and increasing the use of current mammography technology is the most effective strategy we have right now," said Edward Penhoet, director of science and higher education programs at the Gordon and Betty Moore Foundation in San Francisco.
"Mammography saves lives, and we need to figure out a way to get it to patients more uniformly," said Dr. Etta Pisano, chief of breast imaging at the University of North Carolina at Chapel Hill.
