Imagine This: Longer Waits for Mammograms

Despite renewed scientific debate about the value of routine mammograms, women's commitment to the procedure appears to remain strong -- so strong that many local radiology clinics are fully booked four, six and even eight weeks in advance. The demand for appointments peaks at the end of each year, spurred by many insurers' deadlines for using Medical Spending Account funds and for meeting deductible minimums.

While experts were arguing last year over whether X-ray exams of the breast reduced cancer deaths, "patients weren't asking about it," says Laurie Hunt, general manager of GCM Radiologists. The wait for an appointment at one of the practice's several offices in the District and suburban Maryland could be as long as a month or six weeks, she says. "There certainly hasn't been a decline in our numbers." Like others interviewed, Hunt pointed out that faster service is given to women who need diagnostic mammograms, which are ordered when symptoms of breast cancer are detected or suspected.

"It's difficult to accommodate all of the patients" seeking routine screening exams quickly, according to Edward Lipsit, president of Washington Radiology Associates, which performs about 70,000 mammograms a year and has waiting times of up to two months. "There's a lot of anxiety associated with the procedure," he says, and those worries are compounded if a woman "can't have that question answered in a timely fashion."

The declining number of mammography clinics makes "a difficult situation even more difficult," Lipsit says, and "I fear it's not going to get better." Not only is mammography "a very demanding, time-intensive procedure," he says, it is also "one of the leading causes of malpractice claims against radiologists."

"It's really a loss leader," says Diane Guinter, services director for Fairfax Radiological Consultants, which conducts more than 50,000 mammography tests annually. With insurance reimbursement rates low -- an exam for a Medicare patient, for example, might generate $90, in contrast to the $115 or so that the clinic would like to charge -- "some of the smaller practices can't continue to afford them," she says. The wait for a routine mammogram can be a week or even less at some of her group's locations and a month at others, Guinter says.

Radiologist Kae Yingling says a two-week wait is common at her group, Suburban Breast Center.

Are women voicing doubts about the value of mammograms? "Not as much as I would have expected," says Yingling. Most women are proceeding with their exams, she says, if only because there are no better alternatives. "What are they going to do, do nothing?"

For a list of clinics that offer mammograms, see www.fda.gov/cdrh/mammography/certified.html.

-- Tom Graham

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