Access to Breast Cancer Screening Is Endangered

Recent increases in average waiting times for mammograms indicate that breast cancer screening facilities are operating at or near full capacity.56 In New York City, patients waited an average of more than 40 days in 2003 for first-time screening mammograms, as compared with 14 days in 1998; in parts of Florida, waiting times of three months are common.75 Such delays are likely to occur in locations where facilities have closed or where radiologic technologists (the individuals who actually perform mammograms) or radiologists who interpret mammograms—or both—are in short supply. Although no published studies document this trend, there is widespread consensus among breast imagers that workforce issues limit access to mammography and this problem is becoming more acute.

A 2002 report by the GAO found that women in some locations have problems obtaining timely mammography services and raised the prospect of future staff shortfalls, but concluded that the nation’s capacity was “generally adequate to meet the growing demand for these services.”119 Impressions of current capacity within the field of breast imaging are far less sanguine, and that community has criticized the GAO report on several counts.85 For example, they note that it does not distinguish among those radiologists who read some mammograms and those who are breast imaging subspecialists,c and therefore may have overestimated capacity for mammogram interpretation. Although approximately 20,000 radiologists interpret mammograms in the United States,12 only 2,000 of them are members of the subspecialty society, the Society of Breast Imaging. (There are also a small number of nonradiologists who meet the requirements for interpreting mammograms, but the great majority are radiologists, so for simplicity, this report refers simply to radiologists.)

In addition, the GAO may have underestimated the number of radiologic technologists required to meet national mammography needs. A 2000 GAO report found an 18 percent job vacancy rate for radiologic technologists, and a majority of participating hospitals reported greater difficulty in hiring technologists than in the previous year.119 Among radiologic technologists, the number of first-time examinees for mammography certificates has declined substantially each year from 1996 to 2000.85 Moreover, the most recent GAO projections do not take into account the time spent by technologists on activities other than screening, such as performing diagnostic mammograms, breast interventional procedures, and quality assur-

c  

A radiologist can interpret mammograms and other breast imaging examinations (such as breast MRI and breast ultrasound) but not all do. Even fewer radiologists perform breast interventional procedures, such as needle biopsies. A radiologist who identified him/herself as a subspecialist in breast imaging (a breast imager) is either a radiologist who is self-trained and experienced in the specialty, or one who has completed a fellowship in breast imaging.



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