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Mammography Rates Stuck At About 80%

July 21, 2010
Written by: , Filed in: Breast Imaging, Practice Management
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Mammography rates have plateaued in the United States, with almost 20 percent of women age 50 to 74 saying they have not received a mammogram within the past two years, according to the Centers for Disease Control and Prevention (CDC).

The CDC reports that for 2008 (the most recent year for which statistics are available), the overall, age-adjusted percentage of U.S. women age 50 to 74 who said they had received a mammogram within the previous two years was 81.1 percent, compared with 81.5 percent in 2006.

Among the groups with the lowest percentages were women age 50 to 59 (79.9 percent), women who did not finish high school (72.6 percent), Native Americans and Native Alaskans (70.4 percent), women with annual household incomes of less than $15,000 (69.4 percent), and women without health insurance (56.3 percent).

The figures were based on a telephone survey of 120,095 women.

The CDC pointed out that simple access to health-care facilities plays a significant role in screening percentages: “For example, the screening rate varied considerably by geography and was lowest in west-central states, the states with the lowest population densities as well as the states with the fewest mammography facilities.”

The CDC also expects the passage of the Patient Protection and Affordable Care Act to remove some financial barriers to regular screening. The report concludes:

However, the most common reason women give for not having a mammogram is that no one recommended the test; therefore, health-care providers have the most important role in increasing the prevalence of up-to-date mammography among women in the United States.

But once women do get mammograms, then what? The New York Times reported this week that diagnosing the earliest stage of breast cancer, ductal carcinoma in situ (DCIS), “can be surprisingly difficult, prone to both outright error and case-by-case disagreement over whether a cluster of cells is benign or malignant.”

Mammograms can now detect very small breast lesions. Determining whether they are benign or in the early stages of malignancy can be challenging, sometimes leading to false positives that result in unnecessary surgery, radiation, and chemotherapy, not to mention fear, the Times reported.

The Times quoted Shahla Masood, MD, head of pathology at the University of Florida College of Medicine in Jacksonville, as saying the diagnosis of DCIS “is a 30-year history of confusion, differences of opinion, and under- and overtreatment. There are studies that show that diagnosing these borderline breast lesions occasionally comes down to the flip of a coin.”

The Times said that DCIS is diagnosed in more than 50,000 U.S. women each year, and that some estimates say that, if left untreated, it will turn into invasive cancer 30 percent of the time, though perhaps not for years or decades.

The federal government is financing a national study of variations in breast pathology, and the College of American Pathologists has said it plans to start a voluntary certification program for pathologists who read breast tissue, the Times reported.

Related seminar: Pittsburgh Breast Imaging Seminar

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