Why fewer women get mammograms -- and what docs are doing about it

It's a procedure that lasts no more than 20 minutes, delivers 5 to 10 seconds of discomfort and saves lives. But mammograms don't get high marks from many women, despite much effort to alleviate uneasiness or fear of pain. Cost concerns and confusion with insurance coverage might also be why some women aren't signing up for this important screening technique.

A report by The Cochrane Collaboration, an organization evaluating medical research, showed women were not returning for screenings, despite health professionals' efforts to alleviate anxiety or discomfort. That's frustrating for breast-screening experts.

"There's no reason anyone should be dragging their feet to get a mammogram, especially since so many centers have gone digital," prompted Sharon Walenga, a registered mammographer and coordinator of Advocate Lutheran General Hospital's Caldwell Breast Center. That means compression isn't as hard and the quality of images is "incomparable," she said.

A relaxing atmosphere, tranquil music piped into waiting rooms, up-to-date women's magazines, even crossword puzzles and Sudoku, are all techniques to lower anxiety. Advocate has gone several steps further, opening an outpatient, spa-like site in Wilmette, where a concierge greets patients, who are given plush white robes and slippers and private dressing rooms. With Bach playing in the background, images of floating clouds projected onto walls and ceiling and even jasmine tea as a take-away favor, it is the first imaging center in the United States to provide such surroundings for outpatients.

"We understand that anxiety is a part of this whole procedure. After all, it's a test to determine if you have breast cancer," said Camilla Nix, manager of Advocate Imaging Specialists, which operates the Wilmette center. "We address that fear by dealing with it first, by focusing on the patient first. We want patients to feel like they're in charge and don't have to deal with that anxiety alone."

The hope is that women will not view mammograms with such dread. The percentage of women getting mammograms to screen for breast cancer fell between 2000 and 2005 after years of increases, reported a study funded by the Centers for Disease Control.

In 2000, more than 70 percent of women 40 and older said they had recently had a mammogram. In 2005, the numbers fell to 66 percent. Among women ages 50 to 64 -- when mammograms are especially likely to save lives -- the rate fell from nearly 79 percent to 71.8 percent.

Experts are unsure why rates dropped but some experts reason that several issues are playing a part, including an increase in the number of uninsured women and higher co-payments for office visits. In Illinois, Medicare and Medicaid pay for 80 percent of the cost for a mammogram. Also contributing to the drop in screening is uncertainty over the test's value and in some cases, long waits -- a result of rising malpractice litigation against radiologists who read mammograms, resulting in fewer radiologists specializing in breast imaging.

Another reason might be that fewer women use hormone-replacement therapy to treat menopause symptoms. Mammography is a prerequisite before going on HRT.

It is a sad irony that the decrease might also be because fewer women view breast cancer as a threat, since survival rates have increased significantly. The decline in mammography use could mean fewer early diagnoses and reverse recent improvements in breast cancer survival.

"A mammogram may not be the most comfortable procedure to have, but it's only uncomfortable for a few minutes and it does detect breast cancer," said Lisa Garcia, women's imaging supervisor at Edward Hospital in Naperville and a registered mammographer. "Communicating with the patient, explaining the reason for compression, that's the best way we have of alleviating anxiety for our patients. It's also the best way we know of saving women from having to experience breast cancer."