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    Women Facing 'Crisis' in Mammographies

    Report Says Quality Mammography Declining in U.S.

    Clinics Declining

    But experts also worry that screening is becoming harder for women to get at a time when the aging population requires greater access. The number of U.S. mammography facilities declined from more than 9,400 in 2000 to an estimated 8,600 in 2003, a drop of 8.5% per year, according to the report.

    "In the last four years there's been a steady decline," says Janet Joy, MD, the director of the IOM study. The report blames low payment rates from Medicare and high malpractice insurance costs as possible factors in the closings and also says that that a poor financial outlook is keeping new doctors from going into radiology.

    Experts called for wider use of trained, non-physician screeners who can help speed mammography interpretation and may improve accuracy. The U.S. should also move toward consolidated clinics in wide use in the U.K. and Sweden, where tests, interpretations, and even some treatments are all done under one roof, they say.

    Testing Not Rigorous

    While traditional film mammography lags, companies are hard at work developing new, high-tech methods of cancer screening, including computerized digital mammography, gene screens, and specialized magnetic resonance imagers.

    While praising the promise of new technologies, the IOM committee was clear that that not enough rigorous testing is done to see how well the machines function when used in real-world clinics. "The questions asked of new technologies should be which should be used, and when, not which is best," the report states.

    "Too much is based on hype or effective marketing by device makers," Abeloff says.

    Panelists urged device manufacturers, researchers, and health system directors to mount more studies pitting screening methods against one another to see which is most effective.

    Results of one study testing film mammography against five different newer digital mammography machines in nearly 50,000 women are due out in the next year. It's the first study testing traditional mammography against more expensive digital tests, says Etta Pisano, MD, the study's director.

    "This will give us an idea of whether digital is better than film. If it is better it will be a cost to the system to replace film with digital," says Pisano, who is chief of breast imaging at the University of North Carolina Hospitals and a member of the IOM committee.

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