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Women Report Getting Fewer Mammograms, But Why?
Long credited with detecting breast cancer early and saving millions of lives, the mammogram has been a staple of preventive care in the United States. Yet earlier this spring, the National Health Interview Survey showed a startling finding: the number of women who report getting those mammograms has dropped. Rates had increased rapidly from 39 to 70 percent of women over age 40 between 1987 and 2000, then stabilized until 2003. But in 2005 rates reported by women fell almost four percent, according to the journal Cancer (June 15).
The most striking part of the survey, says study author and economist Nancy Breen, Ph.D., at the National Cancer Institute, is that rates dropped most among women who historically have been the highest users of mammography
those between 50 and 64 years of age, who stand to benefit most. Also dropping off in use: those with higher incomes, better educations, good health insurance and a steady source of medical care.
The big question in all this is, why? For now, the reason isn’t clear, though Breen and fellow researchers have some guesses. Among the possible explanations: higher insurance deductibles or copayments, or lower reimbursement for the screening test; skepticism about risk because breast cancer rates have dropped; or new, unfounded doubts about the effectiveness of mammograms themselves. The Institute of Medicine suggests that the decline may reflect a drop in the number of radiologists specializing in breast imaging. As lawsuits against radiologists who have missed diagnoses rise, fewer have gone into the field. There may be shortages, and it may be difficult for women to get appointments, Breen says.
There is also some concern that the recently reported drop in breast cancer incidence might actually be due to decreased mammography rates. That is, fewer women may be getting diagnosed with breast cancer simply because they aren't getting checked out.
“When mammography was [increasing], studies showed an increase in breast cancer incidence as a result. That's because some of the breast cancers that would have been diagnosed later were diagnosed earlier,” Breen says. “What we’re suggesting here is the opposite: if mammography rates decline, then some breast cancers that would have been diagnosed earlier will be in fact be diagnosed later.”
If mammography rates continue to drop, we need to address it. But since intervening is hard without knowing why the problem exists, researchers plan to examine availability of mammogram facilities, insurance coverage, and whether doctors are recommending mammograms. They also want to look at use of reminder systems in physician offices in the United States.