The leading reason doctors give for not recommending mammography is that the test costs $60.
"If you ask physicians why women aren't getting mammography, cost is the first thing they list," said Ladene Larsen, director of the state Bureau of Chronic Disease Control. "Physicians make judgments for patients without checking it out."But in a survey of women conducted in 1989, only 7 percent of Utah women said cost made a difference.
A majority of women questioned who hadn't had a breast X-ray in the past year, 57 percent, said they didn't think they needed one. Another 29 percent said their doctor didn't recommend the test.
The discrepancy in those answers is discouraging to Larsen and other members of the Breast Cancer Task Force, who are working to educate the Utah medical practitioners and their female patients about the risks of breast cancer.
One in nine women gets breast cancer, a disease that has no cure. In Utah, about 200 women die of breast cancer every year.
Yet, for a majority of women with breast cancer, the disease doesn't have to be fatal - if cancers are found while they are less than a quarter-inch in size.
Early detection is key, and mammography is the only available screening test. "The majority of women who develop breast cancer have no risk factors at all," said Dr. Irena Tocino, chief of mammography radiology at LDS Hospital.
In Utah, there are some 200,000 women between the ages of 50 to 70, the ages that experts recommend regular mammograph screenings.
The test is recommended by 12 of the country's largest health-care and medical research organizations, such as the American Cancer Society and the American Medical Association. The groups agree that women without cancer symptoms should begin having mammograms regularly after age 40.
But even those who follow the guidelines aren't guaranteed to get good mammography screen-ing.
During last month's legislative session, Rep. Paula Julander, D-Salt Lake, sponsored HB230, a bill that set minimum training requirements for personnel performing mammography screening and regulates equipment as well. The bill also sets up a $5,000 fund to subsidize screening for low-income women.
The bill originally proposed that Utah insurance companies be required to pay for mammography screenings, as in 36 other states. But that aspect of the legislation was amended. The insurance industry promised to pay for the test but chafed at the idea of a legal mandate.
"Part of the problem is until last year there weren't even mammography questions on the board that certified radiologists," Larsen said. "You can be a podiatrist and read mammograms in this state, in most states actually. The Medical Practice Act is very broad."
More stringent state regulation of mammography facilities was needed, Larsen said. Only 32 of the 47 facilities in Utah that perform mammograms currently meet state inspection standards, based on minimum machinery regulations.
In addition, only six Utah facilities can claim an additional seal of certification by the American College of Radiology.
Operating without that voluntary certification doesn't mean a facility might not take good X-rays and screen them carefully. But that does mean there is little oversight into the care and maintenance of machinery and that technicians aren't legally required to have the additional training necessary to properly detect cancers.
Getting most of mammogram
Only six Utah facilities that perform mammograms are certified by the American College of Radiology.
- LDS Hospital
- University Hospital
- Cottonwood Hospital
- Pioneer Valley Hospital
- Duchesne Medical Center
- Logan Medical Center.
To receive a good breast-screening test, women should ask basic questions, according to Ladene Larsen, director of the Bureau of Chronic Disease Control at the Utah Department of Health.
- How many mammograms does the facility perform each week? The number should be higher than 10. A mammogram is only as effective as the person performing the test or reading the film.
- Does a board certified radiologist read the X-rays? Radiologists are required to take an additional examination, beyond that required of a physician.
- Is the equipment certified with the State Department of Health, proof that it meets minimum standards?
- Is the machinery dedicated just for breast X-rays?
- Does the facility require a physical examination, in addition to the X-ray? Mammography may miss about 10 percent to 15 percent of tumors that are discernible to the touch of a trained examiner.