The long wait
Increased demand, decreased availability mean Rogue Valley women must schedule their mammograms far in advance
Jackson County women have to wait longer than anyone else living along Oregon's Interstate 5 corridor to get the test that is their best defense against breast cancer.
The waiting time for an ordinary screening mammogram has stretched from weeks to months during the past year. More women are asking for the exam at the same time the county's three mammography centers are struggling to fill a void left when the Medford Medical Clinic stopped doing mammograms last January.
We're pulling more people into the system, and we have fewer people to do the work, said Ruth Wade, a veteran mammography technician at Medford's Women's Imaging Center.
Nothing about a mammogram makes a woman eager to schedule one in the first place. Nobody likes waiting to find out whether doctors find something suspicious ' or worse ' on her X-rays. The discomfort alone makes some women reluctant to arrange an appointment.
You just do it, said Glenda Rosenstein of Medford, a veteran of some 20 years of mammograms. It's one of those necessary evils.
Women's health advocates say the long wait for an appointment discourages some women from getting an exam that's already tough to face.
When they make up their mind to do it and they find out it's a four-month wait, they make up ways to push it off even further, said Toni Drew, a Jackson County breast-health educator in the state's Breast and Cervical Cancer Program.
Women's hectic lives make them reluctant to commit to something so far in advance, Drew said. Women are pretty busy. It's hard to schedule things four months down the road. Things get away from you.
Local women who called in November to schedule a mammogram typically couldn't get an appointment until late February or early March at Ashland Community Hospital, Providence Medford Medical Center or the Women's Imaging Center at the Medford Radiological Group. At the same time, mammography centers in Grants Pass, Eugene, Salem, Corvallis and Portland were scheduling patients within days or several weeks.
Only in Douglas County, which lost a mammography center in 2000, do women face waits that stretch as long as three months. Some women now drive to Eugene or Grants Pass to avoid the long waits, said Jackie Barnett, who works in the Roseburg office of the Breast and Cervical Cancer Program.
Local women have no problem arranging a speedy appointment for a diagnostic mammogram ' an exam that physicians request when they see something unusual in a regular screening mammogram.
Dorothy Roberts of Central Point found out how quickly doctors react when they see something suspicious.
They didn't like what they saw on my X-ray, she said. They called me and told me to make an appointment. When they see something they don't like, it's not hard to get in.
Women who discover a lump during their breast self-exam also can get in quickly.
We keep slots every day for a woman who feels a lump, or if a physician feels a woman needs to get in, said Brian Herwig, director of imaging at Providence.
Part of the long wait can be traced to the success of breast-health education programs, which have encouraged more local women to sign up for a mammogram.
These days, almost every magazine you pick up that has anything to do with women has something about breast cancer, said Wade, the mammography technician.
Mammography is one of the most-promoted parts of health care, said Dr. Mack Bandler, a radiologist at the Women's Imaging Center. Women are the most sophisticated consumers of health care.
Recent statistics handily support Bandler's observation. During the past two years, the number of mammograms performed in Jackson County grew three times faster than the number of women most likely to have a mammogram. The number of women age 40 to 74 grew 1.9 percent from 2000 to 2001 (from 37,943 to 38,664, based on U.S. Census figures and estimates from Portland State University). The number of mammograms grew more than 6 percent (from 26,915, to 28,561).
Doing more exams, however, doesn't necessarily mean higher profits for the county's remaining mammography centers. Health insurance companies typically pay about &
36;100 to &
36;130 per exam, which has to cover costs that include equipment; salaries for the people who perform the exam and the radiologists who read the films; and office overhead.
The economic reality is that most mammography providers hope they're not actually losing money on mammography, Bandler said. It's pretty heavily laden with bureaucracy.
The bureaucracy is the result of the Mammography Quality Standards Act. Congress passed the law in 1992 after women complained about the wide variation in mammography procedures among the states. The law sets standards for calibrating mammography machines to ensure accurate readings and requires machines to be regularly tested.
Bandler said the law makes mammography one of just two medical procedures subject to federal standards. The other is renal dialysis.
Reimbursements from insurers simply didn't cover all the costs of mammography at Medford Medical Clinic, said Dr. Keith Williams, one of the physicians who opened the clinic as a partnership on Jan. 1, 2000. The new partnership inherited mammography from its predecessor, the Medford Clinic, and soon discovered insurance reimbursements did not cover the costs of providing the service.
If third-party insurers like Medicare aren't paying enough, it becomes a community service to continue to provide services like mammography, Williams said, and we weren't in a position to do that.
Williams said the Medford Medical Clinic dropped mammography rather than invest several hundred thousand dollars in new equipment to continue to comply with the federal Mammography Quality Standards Act. He noted that no other group has jumped into mammography to fill the niche his clinic formerly occupied.
No one's rushing in to fill that void, he said. They all see the pitfalls we were struggling to get out of.
We got out. Others aren't getting in. The problem's hardly our fault.
He compared mammography to unfunded mandates ' laws that federal and state governments hand down to local jurisdictions without money to pay for compliance with them.
We create public expectations of what (mammography) screening should be, he said, but there aren't reimbursements to support it.
The economic realities of mammography have prompted clinics in other regions to drop the service, too. National media reported extensively on a mammography crisis in 2000, but those stories had little meaning here until this year.
This is a national problem, Bandler said. We're better than many, worse than some.
Bandler and his colleagues at the Women's Imaging Center plan to add another mammography machine next year, as well as to recruit technicians to operate it and a radiologist to interpret the images.
Meanwhile, many women who are waiting months for their mammogram feel wronged by a system that sends them mixed messages. The way things are going, we're not having a mammogram every year, said Jane Verdieck of Medford. We're having one every year and a half.
Chris Abbey, assistant Tempo editor at the , contributed to this story.
Reach reporter Bill Kettler at 776-4492, or e-mail Longer waits might not make a difference Waiting an extra four months for an annual mammogram probably won't have a significant health effect for most women, said a Portland epidemiologist.
It's probably a little bit of an excess risk, but not a lot, said Dr. Donald Austin of Oregon Health & Science University.
Austin based his conclusion on Swedish studies that found a relatively small incremental health benefit for women who had annual mammograms over those who had the exam every two years.
In the Swedish studies, women who had an annual mammogram experienced a 30 percent reduction in mortality from breast cancer over those who did not get a mammogram. Those who had the exam every two years had a 24 percent mortality reduction.
Austin said the difference probably would be substantially less if mammograms were done at 16-month intervals, but no studies have been done under those conditions.Cancer society's recommendations The American Cancer Society recommends women over 40 should have a mammogram every year. In addition:
Women 40 and older should have a physical examination of the breast every year, performed by a health care professional such as a physician, physician assistant, nurse or nurse practitioner. This examination should take place near and preferably before the annual mammogram.
Women ages 20 to 39 should have a physical examination of the breast every three years, performed by a health care professional.
Women 20 years of age and older should perform breast self-examinations every month.
Mammograms can be scheduled at:
Ashland Community Hospital, 482-2441.
Providence Medford Medical Center, 732-5082.
Women's Imaging Center, Medford Radiological Group, 773-6251.