Mammogram rates decrease

As the risk pool increases, experts have theories on why fewer women are getting mammograms

In 1972, Donna Myers had a lump in her left breast. The lump was malignant, and doctors removed her breast. Two years later, Myers -- then 49 -- developed a lump in her right breast. That breast was removed, too.
At the time, mammograms weren't around. But now the technology is widely available. However, a recent study says fewer women are taking advantage of it.
Dr. Nancy Breen of the National Cancer Institute and co-authors of a published a study in June in CANCER, a journal of the ACS , found mammography rates had dropped. Their study showed that nationwide, mammography rates fell by up to four percentage points from 2002 to 2005 among women 40 and over. The rates went from 70 to 66 percent, according to the journal. The difference is statistically significant.
Among women age 50 to 64, the drop was almost 7 percent, according to the study published in CANCER. This is especially troublesome because the older women get, the greater their chances for getting cancer.
Breen and the study's other authors reviewed National Health Interview Survey data from 1987 to 2005, according to the ACS.
"The best thing you can do is find out the answer," said Myers, who's now 81 and said she's enjoying a full life with her husband of 60 years in Menlo Park. She now speaks to groups several times a year about her experience and the importance of screening. "If you do have it, you need treatment right away."
Complacency might seem like an obvious reason behind the declining rates but, anecdotally, others say reasons include women having to pay more for mammograms as their insurance covers less. Also, reimbursements to doctors are decreasing. Some doctors won't even do mammograms anymore.
Tricia Baker a technologist and is the director of the Breast Care Center at Good Samaritan Hospital.
"Reimbursement from insurance companies is pathetic," she said. A mammogram costs about $500, but doctors who use Medicare will often only get reimbursed $90.
Baker said equipment manufacturers have also "done a terrific job" of advertising digital equipment that can cost $400,000. Many patients want "the latest and greatest" and will look for doctors who have it. However, many doctors can't afford that kind of equipment.
When Baker started doing this work almost 20 year ago, the incidence rate for breast cancer was one in 11. Now, she said, it's one in seven.
She said she's noticed her facility isn't as busy as it used to be, but the reasons aren't necessarily related to anyone's feelings about mammograms. She said the insurance company they did a lot of work with went out of business. The patients covered under that insurance program were either sent to Kaiser Permanente, or to another facility.
However, Baker said another problem is the mixed messages that women get. The American Cancer Society recommends women get a mammogram every year once they turn 40, while the American College of Physicians says "wait until your 50."
Getting a mammogram is often relatively painless, Baker said, but it can be like going to the dentist.
"If women can avoid doing it, they'll avoid doing it," she said.
Baker said she helps do outreach through health fairs and also helps uninsured women get help through a state program.
Mary Nacionales directs the Women's Health Partnership Program, part of Santa Clara County's Community Health Partnership. She works with uninsured and underinsured women in Santa Clara and San Mateo counties, most of whom are Latina.
Nacionales said she couldn't comment on what's going on in the general population, but she said there are problems among the population she works with.
"This population doesn't have access to regular mammogram screening," she said. Nacionales said the factors include cost, lack of transportation and a lack of cultural sensitivity. She said many of the women she works with put work and family needs before their own health needs.
In order to help, Nacionales' program has started a mobile mammogram program, so that women can have better access to care, and know where to find it.
"It's all about awareness," she said.
The Women’s Health Partnership program has helped organize mobile units at 16 clinics. As of July, 619 women had been screened. Almost all of them have said they want to be screened annually, Nacionales said.

Seth Hemmelgarn is a contributing writer for Healthcare Journal of Northern California. You can reach him at