Just a Bump in the Beltway

Is the Future of the Mammogram in Jeopardy?

Reprinted with permission from The Billings (Montana) Gazette.

Searching for a snowman in a blizzard. Spotting a star on a cloudy night.

That's how radiologists describe looking for cancer on a mammogram.

It's white on white -- white tumors on white breast tissue -- and it can be very difficult to see, even for the most experienced eye.

Mammography is arguably the most difficult thing radiologists do, but it is also one of radiology's most common and most important practices.

"This saves more lives than anything else we do," said Dr. Joseph Dillard, a radiologist with Eastern Radiological Associates in Billings.

Even so, Dillard and hundreds of other radiologists across the country have begun refusing to read mammograms, a trend some say could eventually limit women's access to the cancer screening tests.

Reliable statistics are hard to find, but one U.S. study published in 2005 found that 30 percent of positions for radiologists who read mammograms were vacant. Radiologists also interpret X-rays, ultrasounds, CT scans and MRI exams.

The same study, reported in the journal Cancer, found that 63 percent of radiology practices with mammography fellowships had unfilled fellowship positions. Fellowships are programs that provide specialized training in specific areas of medicine.

At Eastern Radiological Associates, which is affiliated with St. Vincent Healthcare, three of seven radiologists are willing to interpret mammograms. At Billings Clinic, five of nine will do it.

Meanwhile, the number of certified mammography facilities is declining.

There were about 11 percent fewer places to get mammograms in the United States in 2006 than there were six years earlier, according to the government. That's 1,101 fewer mammography centers across the country.

So, what gives?

In short, radiologists are afraid of being sued, and there's evidence that they have more reason to worry than providers in other areas of medicine.

Okay, let's add another roadblock to women's health care. My "insurance," although it seems foolish to use the word, doesn't include "well woman" care, including mammograms. The upshot is that at 53, I've never had a baseline mammogram and won't be getting one now.