Breast cancer screening situation will get worse

According to a recently published study, community-based mammography facilities do not have enough radiologists and certified technologists to adequately deliver screening and diagnostic services to the public, and the situation will probably get worse.

In a survey of 45 mammography facilities in three states, Washington, New Hampshire and Colorado, done from 2001-2002, researchers found that if issues causing staff shortage are not addressed more facilities will close and screening will become more centralized, and this might make screening and diagnostic mammography impossible for some women.

The study led by Carl D'Orsi, M.D., professor of radiology and director of the Breast Imaging Center at Emory University in Atlanta, found that 20% of facilities reported a shortage of Mammography Quality Standards Act (MQSA) qualified technologists, and nearly 46% reported difficulty in maintaining qualified technologists.

85 % of the facilities were reported as being able to schedule diagnostic mammograms within one week of a request, while only 30% of facilities had the ability to schedule screening mammograms within a week, 47% reported a wait of two or more weeks for screening mammography. In high-volume facilities, the scheduling delays for both diagnostic and screening mammography were two to three times higher than in low-volume facilities, with some facilities reporting waiting times of up to four weeks for a diagnostic mammogram.

Distinct regions of the country are represented in the survey and are part of a breast cancer consortium with access to a great amount of data.

Dr. D'Orsi says this is a community-based report that fits the profile of the rest of the country and indicates that the results are reflective of national trends.

Staffing shortages could have significant clinical implications in the early detection of breast cancer say the researchers, and with fewer radiologists choosing breast imaging as a specialty and a decline in the number of technologists testing for mammography certification, community facilities will not be able to meet the increasing demand for mammography services, leading to further delays in diagnosis and a potential increase in interpretive errors.

According to the American Cancer Society, 211,240 American women will be diagnosed with breast cancer in 2005, and 40,410 will die from the disease. Mammography is currently considered by most experts to be the most effective routine screening tool available for early detection of breast cancer.

Dr. D'Orsi says that steps must be taken to solve the staffing problem, including more efforts to attract radiologists and technologists to the specialty, increased mammography reimbursement and more education on all aspects of breast imaging, so that facilities providing these crucial services in the community remain clinically and financially viable.

He advises women currently seeking mammography to make sure that the facility and its personnel meet FDA requirements and to inquire about the experience of the radiologists on staff.

The report is published in the May issue of the journal Radiology.

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