Mammogram Rate Declining, Study Suggests

Finds First-Ever Drop In U.S., As Much As 4 Percent, In Women 40 And Older

(CBS)  Women older than 40 are supposed to have mammograms every year to try to spot breast cancer early, but a new study suggests that fewer women in that age range have been getting them in recent years.

Research by Dr. Nancy Breen of the National Cancer Institute, among others, shows the mammography rate fell by as much as 4 percent nationwide between 2000 and 2005.

The report's authors call that drop "significant" and say theirs is the first study to detect that the decline is nationwide.

The study appears in the June issue of the journal Cancer of the American Cancer Society.

Some of the sharpest declines were seen among women who previously reported high screening rates — women between 50- and 64-years-old, and women in higher socioeconomic levels.

Dr. Breen and her co-authors noted that the dip in screening rates coincides with a fall in the reported cases of breast cancer, and say they "are concerned that some of the observed decline in incidence (of breast cancer) may be due in part to the leveling-off and reduction in mammography rates."

On The Early Show Monday, Dr. Michele Blackwood, a breast cancer surgeon and medical director of the Connie Dwyer Breast Center (www.cathedralhealth.org/connie_dwyer.html) in Newark, N.J., called the possible trend "scary."

She told co-anchor Julie Chen the drop among women 50-64, "the baby boomers, the well-educated, the ones with the most insurance" is "shocking." Their decrease is seven percent.

One factor, Blackwood noted, may be the sudden drop in the use of hormone replacement therapy for the symptoms of menopause, after a 2002 study tied HRT to an increased risk of breast cancer and heart disease. Many women in that age group had gotten into the habit of going to their doctors for hormone replacement therapy, and getting annual mammograms as part of that process. When women stopped visiting their doctors for HRT prescriptions, they may not have continued going just for mammograms.

Another possible factor is the closing of roughly 10 percent of mammography centers in the U.S. due to lower insurance reimbursement rates for the procedure as well as a rise in lawsuits.

Some complacency may also be at work here, Blackwood said: The medical community has done such a good job of treating breast cancer and making it less of a death sentence that certain women may have lost their fear of the disease. Of course, it's early detection that allows for more successful treatment.

"Breast cancer can be cured if it's caught in an early stage. The way to do that is to have an annual mammogram," Blackwood stressed. "If you're in your 40s or 50s, you have 25 to 40 percent less chance of dying from breast cancer if you have an annual screening mammogram."

Blackwood offered suggestions on how women older than 40 can remember to get their annual mammograms. One was to tie it to an important date, such as your birthday or that of someone in your family. Also, go for the test with someone you know: "Bring them with you. Make a day of it! Go to lunch." And pamper yourself afterwards, with something simple, such as having your nails done.

"You shouldn't be dreading" having a mammogram, Blackwood said. "You're doing something good for yourself" that day.

As for women who don't have their own doctor or health insurance, Blackwood said, "Actually, there are many programs around the country sponsored at the state, county or city level where women can go for convenient mammograms that are free or very inexpensive. Women should call their local health authorities to find out how to obtain those mammograms."

So, she concluded, there's no excuse not to get a mammogram!

"If I told you I had a cheap way to spend just a few minutes and help yourself prevent a serious disease, wouldn't you take advantage of it? That's what a mammogram is. It's as simple as that."

[soquilii]

I can tell you why the rate is declining. The treatment most of us receive when we get a mammogram is despicable. Who wants to be treated like a piece of meat?
Plus it hurts like hell.
I had one and I can tell you I don't intend to have another one.

[soquilii]

I can tell you why the rate is declining. The treatment most of us receive when we get a mammogram is despicable. Who wants to be treated like a piece of meat?
Plus it hurts like hell.
I had one and I can tell you I don't intend to have another one.

[jules196006]

Mamograms are expensive. According to your commentary there is financial help in all 50 states for anyone 40 and over who cannot afford to get a mamogram. In South Dakota, I am able to get a pap smear under low income financial guidelines; however, you cannot qualify for help on a mamogram until you are 50 years of age.

[jules196006]

Mamograms are expensive. According to your commentary there is financial help in all 50 states for anyone 40 and over who cannot afford to get a mamogram. In South Dakota, I am able to get a pap smear under low income financial guidelines; however, you cannot qualify for help on a mamogram until you are 50 years of age.

[meysmith2]

Why is it that what is true is never reported. What riduculous facts were listed by this doctor as to why women do not go annually for. 1st her report that every county has free mammograms is questionable. The truth is (and I must inform you that no matter how hard I try to be different, I'm always middle of the road) mammograms are awful! I was told about 10 years ago that a more dignified, less painful mammogram was developed so that when it was time for myself to begin annual exams it would not be this horrible process. That has not happened.

[meysmith2]

(continued) If Health Care truly were concerned that women should have mammograms they would put some $ into developing or supporting a system that already exists that does not flatten the breast so painfully. And those conducting the mammogram would have more caring for those undergoing the exam. YES, it's us stupid women who hate being treated as less than human that have trouble going - can't get above it. And even if the staff who performs the procedure are kind - one still leaves with the feeling of being abused. How ignorant we are not to want to lose our dignity, but sometimes it's all we truly have and life's too short to act like it's a "pampering" day to have this done. I will continue to have mammograms every 2 YEARS not annually (it's what my insurance supports) and hope that dignity will be brought to this process. And I must add, I know NO woman whose willing to subject herself to this annually - even my friends who've had breast cancer go in fighting when it's time for this THING.

[meysmith2]

If Health Care truly were concerned that women should have mammograms they would put some $ into developing or supporting a system that already exists that does not flatten the breast so painfully. And those conducting the mammogram would have more caring for those undergoing the exam. YES, it's us stupid women who hate being treated as less than human that have trouble going - can't get above it. And even if the staff who performs the procedure are kind - one still leaves with the feeling of being abused. How ignorant we are not to want to lose our dignity, but sometimes it's all we truly have and life's too short to act like it's a "pampering" day to have this done. I will continue to have mammograms every 2 YEARS not annually (it's what my insurance supports) and hope that dignity will be brought to this process. And I must add, I know NO woman whose willing to subject herself to this annually - even my friends who've had breast cancer go in fighting when it's time for this THING.

[meysmith2]

If Health Care truly were concerned that women should have mammograms they would put some $ into developing or supporting a system that already exists that does not flatten the breast so painfully. And those conducting the mammogram would have more caring for those undergoing the exam. YES, it's us stupid women who hate being treated as less than human that have trouble going - can't get above it. And even if the staff who performs the procedure are kind - one still leaves with the feeling of being abused. How ignorant we are not to want to lose our dignity, but sometimes it's all we truly have and life's too short to act like it's a "pampering" day to have this done. I will continue to have mammograms every 2 YEARS not annually (it's what my insurance supports) and hope that dignity will be brought to this process. And I must add, I know NO woman whose willing to subject herself to this annually - even my friends who've had breast cancer go in fighting when it's time for this THING.

[neenga]

My regular mammogram facility sent a letter saying they no longer accept United Health Care plans, so I either need to grab my records from this place and go someplace new, or pay out of pocket. I don't see that insurance companies or radiologists do much to encourage mammograms.

And as you all say, it is a humiliating, painful experience. Once men are tested similarly for testicular cancer, the technology will change

[ajaxrose1]

As if one invasive test every year for our "own good" isn't enough, they added another one. If they're so concerned about it then they need to come up with a less painful and inconvenient way to do it. The people I know who've had breast cancer (several, by the way) have ALL found it on their own, one was a full week AFTER she'd been cleared by the stupid mammogram. Personally, I think it's just another way to put money into the pockets of companies that own the technology. And I agree, if there's ever a recommendation that men get their "personals" squashed all to heck to check them out, then things MIGHT change. Not too likely, though.

[ajaxrose1]

As if one invasive test every year for our "own good" isn't enough, they added another one. If they're so concerned about it then they need to come up with a less painful and inconvenient way to do it. The people I know who've had breast cancer (several, by the way) have ALL found it on their own, one was a full week AFTER she'd been cleared by the stupid mammogram. Personally, I think it's just another way to put money into the pockets of companies that own the technology. And I agree, if there's ever a recommendation that men get their "personals" squashed all to heck to check them out, then things MIGHT change. Not too likely, though.

[ajaxrose1]

As if one invasive test every year for our "own good" isn't enough, they added another one. If they're so concerned about it then they need to come up with a less painful and inconvenient way to do it. The people I know who've had breast cancer (several, by the way) have ALL found it on their own, one was a full week AFTER she'd gotten the "all clear" from the stupid mammogram. Personally, I think it's just another way to put money into the pockets of companies that own the technology. And I agree, if there's ever a recommendation that men get their "personals" squashed all to heck to check them out, then things MIGHT change. Not too likely, though.

[tngreen]

Thank you ladies! I have always said that when they start using those @#$%* things to check for testicular cancer, you will have a new technology within 6 months. It is good to hear from others who feel the same way. What kind of *** came up with this thing anyway? My doctor tricked me into getting one when I turned 40. The next time I saw him I told him that I would get the next one in another 40 years.

[neenga]

My regular mammogram facility sent a letter saying they no longer accept United Health Care plans, so I either need to grab my records from this place and go someplace new, or pay out of pocket. I don't see that insurance companies or radiologists do much to encourage mammograms.

And as you all say, it is a humiliating, painful experience. Once men are tested similarly for testicular cancer, the technology will change

[cindycpa]

Funny...I just returned to work from my annual mammogram about an hour ago. Very slight discomfort, if any...well worth the peace of mind. Want to be rid of the breast compression? Answer: adaptation of MRI equipment solely dedicated to diagnosing breast cancer. According to the technician I spoke with this morning, a mammogram costs between $150-$200 while an MRI costs $2K. If we pressure manufacturers to develop MRI equipment dedicated solely to breast cancer diagnosis, the equipment costs would be reduced thereby enticing our insurance companies to pay for the less invasive, more accurate MRI procedure.

[cindycpa]

Funny...I just returned to work from my annual mammogram about an hour ago. Very slight discomfort, if any...well worth the peace of mind. Want to be rid of the breast compression? Answer: adaptation of MRI equipment solely dedicated to diagnosing breast cancer. According to the technician I spoke with this morning, a mammogram costs between $150-$200 while an MRI costs $2K. If we pressure manufacturers to develop MRI equipment dedicated solely to breast cancer diagnosis, the equipment costs would be reduced thereby enticing our insurance companies to pay for the less invasive, more accurate MRI procedure.

[erasmus6]

The reason why there is probably less breast cancer IS because less people are going for mammograms! Getting a mammogram is RADIATION! Radiation causes cancer. Not only that it isn't good how they squish the breasts, that could cause problems also. In Canada we all have healthcare so it doesn't cost us anything to get a mammogram, but I don't care, I still am not going to get one!

[godofredo29]

Yeah, just to respond to tngreen, if testicular ultrasounds were promoted the way mammograms are (i.e., recommended for men in at risk groups, such as men up to 25), the cure rate would be almost 100%. The problem? It would cost money and we know ultrasounds are already cheaper than dirt. When it comes to men's health, it's the Titanic model of health care that applies.

This is pure spin off the research recently published in the much more prestigious and important Annals of Internal Medicine, by the American College of Physicians, showing that mammography screening for women under 40 is not beneficial and may even be harmful. The harmful effects may include exposure to radiation, unnecessary biopsies, surgery, and chemotherapy and it's recommended that women and their physicians make this decision on a case-by-case basis. CBS News should have presented the other side of this story and should not have allowed Dr. Blackwood to make up "scary" theoretical trends which have no basis in fact.

[meep318]

Why are these comments not shared in the news stories?? In all the 15 years I have gotten mammos, only ONE of the persons doing them was gentle and compassionate about how much it HURTS!! I agree that if men had to endure these, the technology would change quickly. Last year was the first year I skipped mime, and I feel guilty about it, but just dread the whole experience.

[erasmus6]

I know of several women who have had breast cancer and it was not detected through regular mammograms, it was the doctor that found something.

[solaria-2009]

Yes it can hurt but if you get a good technician who knows what she's doing, that can be kept to a minimum. And it's not like it lasts for hours and hours--it's only a few minutes of discomfort. A small price to pay.

[misschris49]

If fewer women are getting mammograms, my belief is that the reason boils down to dollars and cents. Insurance coverage worsens each year, with companies putting a larger percentage of the costs on its employees and their dependents. And, as hospital procedures become more expensive, the patient's share of the costs are rising considerably. Women are practical and also usually put the needs of the family above their own. They would certainly skip their mammogram for a year, or even two or three, if other family needs are deemed more important.

[scottiemac52]

What a bunch of babies! I've been getting mammos for 20 years and the actual four compressions (two views per breast) take about fifteen seconds each. Geez.

As for radiation, the amount in a standard mammogram is the same as daily background radiation (the kind we are all exposed to just walking around) we get in 3 months. By contrast, a CT scan involves 3 years' worth of radiation. And the dose received these days is far lower than 20 years ago due to improved equipment, especially digital versus film mammography.

As for ultrasound:

"Ultrasound has excellent contrast resolution. This means, for example, that an area of fluid (cyst) and an area of normal breast tissue are easy to differentiate on an ultrasound image. However, ultrasound does not have good spatial resolution like mammography, and therefore cannot provide as much detail as a mammogram image. Ultrasound is also unable to image microcalcifications, tiny calcium deposits that are often the first indication of breast cancer. Mammography, on the other hand, is excellent at imaging calcifications. Ultrasound may be able to detect macrocalcifications (larger calcium deposits) in some cases.

Though most true breast lumps will be found by mammography or ultrasound, some abnormalities escape detection on both imaging tests. For example, a lump may be able to be felt but does not appear on mammography or ultrasound images. If this is the case, then fine needle aspiration biopsy (FNA) is often performed."

[carolull]

The reason that I (I am 48) only get a mammogram every two years is that my health insurance only
covers it every two years, even though I am over 40. This could be one reason that many women don't get it done according to what is recommended.

[erasmus6]

They may say that there is little radiation but if you consider that you have it once a year or whatever and then there is the xrays that you get from the dentist or other xrays you have through out your life. The radiation from your televisions, smoke detectors, the list goes on and on. The point is, that the radiation that you get, NEVER leaves your body, EVER!

[sheriimage]

3 things influence me to stall having mammograms: a rude skinnymini (I am far from skinny), after-pain lasting many days due to spondylosis, disk degeneration, and osteoarthritis, and a mistakenly sent test-positive letter over Thanksgiving weekend.

[sal567]

My last mammogram was five years ago. It was so painful up to now I cannot bring myself to undergo another torture. Until they find a less excruciating way of testing I'll just take my chances and hope the cancer cells will elude me.

I believe some of the answer could become clear if you correlate your April 7, 2007 story about computerized mammogram readings with the date this computerized processing began. I still recall its beginning, yes gee, around year 2000, because it DOUBLED the price of a mammogram. Even if uninsured or partially insured women could afford it before, they can't now. So I agree with MissChris49. What's changed is the cost.