The Mammogram Crisis

HEALTH

By Salvador Quiroz

The mammogram is a radiographic study of the human breast. While 98 percent of patients undergoing this procedure are women, the remaining two percent are men. This may come as a surprise to some people, but males are also born with mammary glands that tend to atrophy with time. But because all men produce a small amount of estrogen (which the liver metabolizes), sometimes there is a persistency of these mammary glands, a condition that is called gynecomastia. Other times, the remaining mammary tissue in males can be stimulated to grow with the use of certain medications, mainly some of those that control high blood pressure. I say this so you won’t be surprised to know that mammography is a procedure that is also used for male patients.

Studies have shown that routine mammograms can decrease the risk of dying from breast cancer by as much as 40 percent. In the United States, about one million women are turning 40 each year, the age when many doctors say that annual screening should begin. If you add this number to the women already screening themselves on a yearly basis as part of their routine gynecological check-up, the number of mammograms done every year is astronomical. It doubles approximately every 10 years and accounts for the more than 10,000 mammogram units in the United States.

Despite all this, mammography centers are scaling back or even closing because of inadequate reimbursement rates and malpractice fears. With access shrinking, women often have to wait months to schedule an annual breast cancer screening and may then decide to skip it altogether. Not only that, but even women with suspicious lumps may have to wait several weeks to get this test done. This can delay the diagnosis of breast cancer and result in tumors being detected at later, less treatable stages.

Screening mammograms typically cost between $75 and $100, while a diagnostic test, performed when a problem is suspected, may cost well over $200. Recommended Medicare reimbursement rates, set by Congress, are well below that—$67 for a screening mammogram and $81 for a diagnostic test.

That cuts into the budget of many centers, and therefore many are closing or reducing their services. One of the most prominent closures occurred in 1999, when the NYU Medical Center shut one of its two mammography centers for financial reasons.

If we add to this concerns over malpractice—because the exam misses 10 to 20 percent of cancers—and hence malpractice insurance rates, medical residents who would be mammographers are choosing other specialties. So the people required to deliver the service are not going into the field. This, then, is the mammogram crisis in the United States.

But the good news is that we live in San Miguel de Allende, and there is no crisis here. A mammogram costs US$67, and there is no waiting list. So, whether it is here or elsewhere, all women over the age of 40 should be screened on a yearly basis as part of their routine checkup, and definitely all patients (male or female) with suspicious breast lumps must have this exam.

 

Dr. Salvador Quiroz, Internal Medicine and Kidney Disease, Hospital H+, Graduated from the Mayo Clinic. Tel: 152 2329.

 

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