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Why Haven't You Had a Mammogram?

Despite the fact that mammograms save lives, approximately 18 million women in the U.S. who should have had the test in the past two years haven't, according to the Centers for Disease Control and Prevention (CDC). The reasons why so many women miss their regular breast screenings are complex and cause concern among experts. After all, early detection of breast cancer boosts the chances of survival to 98%. But a shortage of imaging centers, long waits to schedule an appointment, and anxiety about what a mammogram might reveal conspire to keep women from having this lifesaving test. To keep yourself healthy, check out our tips for creative ways to counter every barrier (and excuse).

By Janis Graham

It's Too Far

Increasing numbers of women nationwide have trouble finding an imaging facility within an easy drive. That's because more than 750 mammography centers have shut down in the past few years, a result of small profit margins, high liability insurance, low reimbursement rates from insurers and a shortage of radiologists.

What you can do

Buddy up, so you can make getting a mammogram a chance to spend time with a friend. Get back-to-back screening appointments, split travel expenses if you have a substantial drive, then go out for lunch afterward. Or consider using a mobile mammography service—traveling vans that offer screenings. Your local health department or hospital should be able to tell you when one is swinging by.

Nobody Told Me To

In a recent study of more than 3,000 women who hadn't had a recent mammogram, 80% said the reason was simply that their doctor didn't suggest it to them. Without a professional's urging, it's all too easy to sideline annual screenings. In addition, if a woman visits her doctor only when she's sick, it may leave little time for prevention-oriented talk, notes one of the study's authors, Nancy Breen, Ph.D., an economist with the National Cancer Institute.

What you can do

Don't count on receiving a postcard or phone call reminding you to get an annual mammogram, says Breen. "Few doctors' offices have these kind of reminder systems in place." Instead, accept that having regular mammograms is like wearing sunscreen or eating right—an aspect of your health that you have to take charge of yourself. Be proactive about getting a referral to a breast center, making an appointment and following up on results.

They're Booked

Fitting a mammogram into your hectic schedule is one hurdle. Getting the imaging center to fit you into its overbooked calendar is another. While one study of 45 mammography centers in Washington, New Hampshire, and Colorado found that wait times for scheduling a routine screening mammogram ranged from one to eight weeks, other research reveals that in New York City some centers have no openings for four to six months. Rhode Island centers report waits of up to 143 days for an appointment.

What you can do

Shopping around for a center with a short wait may not be possible where you live. And it's not necessarily the best strategy—facilities with the longest wait times are typically the ones with the most experienced staff and the best track records for accuracy. Consider booking the same date every year (so you won't forget), such as the day before or after your birthday. Schedule your next appointment after you finish a screening, while you're still at the radiologist's office.

I'm Scared

If you've been avoiding mammograms because you're secretly terrified cancer might be found, worried about radiation exposure, or anxious about the embarrassment, discomfort, or pain you might experience during the procedure, you're not alone: Studies reveal these are very common concerns, according to Lydia Komarnicky, M.D., chair of the department of radiation oncology at Drexel University College of Medicine in Philadelphia.

What you can do

Talk to your doctor, mom, or friends about the breast X-ray. Women who do so are more likely to get screened than those who don't. Remember that today's mammograms deliver very little radiation, and while there is some discomfort, it lasts only a few seconds. Try to schedule the test right after your menstrual cycle, when your breasts are typically less tender. Taking two ibuprofen or acetaminophen a half hour before your test also can help.

A Test You Can't Afford to Skip

"When a woman has to pay all or part of the cost of a mammogram out of her own pocket, studies show she's less likely to have one," says Sally W. Vernon, PhD, a professor at the University of Texas Health Science Center at the Houston School of Public Health. As many as 21% of women in the U.S. say they can't afford mammograms, according to research from the National Women's Health Resource Center.

But in reality, 52% of women overestimate the cost of a mammogram and 40% underestimate how much insurance will pay. The price for a mammogram ranges from $50 to $150, but women with any kind of health insurance are not likely to pay more than $12 out of pocket. In addition, low-cost or free mammograms are available in most places. For more info, call the American Cancer Society at 800-227-2345.

Digital Technology

Experts have a nagging worry that some women are putting off their mammogram until their hospital switches over to digital mammography. This new technology has been shown to be more accurate than traditional film mammograms in women under 50 with dense breast tissue. But only a third of all mammography units in the U.S. are digital right now—and most are in facilities on the East and West coasts.

When you call for an appointment, ask about digital, but if it isn't available, stay on schedule with film mammography, which has been used for more than 35 years and still significantly reduces the risk of death from breast cancer. You can take steps to increase the accuracy of the test: Ask if your film can be read by more than one radiologist, which reduces the risk of missing a problem by up to 15%. Or request your film be analyzed by CAD (computer-aided detection), which helps call attention to areas of concern. And be sure your new films are compared with those taken in the past. Changes from one year to the next can be telltale.

Beyond the Mammogram

While mammograms are quite reliable for postmenopausal women without dense breast tissue—up to 90% successful at finding tumors—for other women the screening test's track record isn't as stellar. Mammograms detect less than half of all breast cancers in premenopausal women under age 50 who have dense breast tissue. But don't panic if you fit this description. You might be a candidate for an ultrasound screening, a painless breast exam that uses high-frequency sound waves to detect tumors. When administered along with a routine mammogram, an ultrasound finds 28% more cancers in women at increased risk than mammography alone.

Major health organizations, such as the American Cancer Society, have not issued guidelines on who should have an ultrasound screening. Not all insurers cover the extra test either. So you and your doctor will need to carefully consider the option, especially since the mammography-ultrasound combo results in more false positives, leading to unnecessary biopsies in 1 out of 10 women, compared with 1 in 40 unnecessary biopsies for mammography alone. As scary as this sounds, study author Wendie A. Berg, M.D., Ph.D., points out that a biopsy is a 15-minute office procedure that's performed with local anesthesia and requires no stitches.

And for women at very high risk for breast cancer (like those with the hereditary gene mutation BRCA1 or BRCA2, or a mother or sibling with the gene), a mammogram plus ultrasound isn't enough. Instead, they should get a mammogram along with magnetic resonance imaging (MRI), which detects about 91% of cancers. The American Cancer Society recommends women in this very high-risk category begin getting MRIs and mammograms at age 30.

To check if the mammography center you go to is accredited by the American College of Radiology, which monitors quality of equipment, personnel and safety, go to acr.org and click on Accreditation.

Originally published in the October 1, 2008, issue of Family Circle magazine.

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