Playing with Fire

Why more women could get burned.

By Delthia Ricks

Few Carolina women look forward to their annual mammogram, but the potential benefits outweigh the discomfort and time commitment.

Yet, a recent report shows that mammography use is decreasing throughout the United States, a trend that has some experts worried.

Dr. Nancy Breen of the National Cancer Institute pinpoints a decline of 4 percent in a study published in the journal of the American Cancer Society.
Although it may sound like a small percentage, that figure amounts to thousands of women who are eschewing their annual mammograms.
Breen says it is difficult to say precisely why women are forgoing these tests, but the biggest drop-off in screening has occurred among those 50 to 64, the group that would benefit most.

“It is not good news,” Breen says. “This is a screening that has good scientific data behind it, and it saves lives. There is no reason that women should be screening less.”

In her analysis, Breen notes that from the late 1980s through 1992 there was a sharp increase in the number of women who underwent yearly mammograms.
An estimated 30 percent of the eligible population was screened in the 1980s, and by 1992, 56 percent were undergoing the test.

Her analysis, which focused on screenings from 2000 to 2005, found that the overall population that was screened reached a plateau in 2000. Since then, declining usage has been glaringly evident.

“There was a 7 percent drop in women 50 to 64,” Breen says, with a 4 percent decline overall during that period.

“And what's striking is that it seems to be among women with high incomes, who are well-educated, with private insurance, and who historically have been high screeners.”

In New York, declining mammography usage has become so apparent that the American Cancer Society formed a “strike force” to investigate, says Dr. Clare Bradley, who is a board member of the organization's eastern division.

“There are many things at play, not only one thing,” says Bradley.
“There are more women who are uninsured. There are more women who are eligible for mammography as we move forward because the population as a whole is aging, but there are not enough slots for women who need mammograms,” she explains, referring to centers that have gone out of the mammography business.

Breen says the number of radiologists who specialize in mammography also is on the decline.

Breen and Bradley theorize that some of the reduction may be attributed to a controversy that arose five years ago.

The Physician's Data Query, a panel of experts at the National Cancer Institute, questioned the effectiveness of mammography.

Their concerns followed highly publicized studies by Swedish researchers published in The Lancet in 2001, which also questioned mammography's effectiveness.

Breen says statistics in her study show that the decrease in screening began when each of those studies captured headlines.

Her biggest fear: A drop in mammography could mean cancers will be detected later, when they are more difficult to treat, reducing chances for long-term survival.