More Mammography Centers Closing

BOSTON -- "After almost 20 years of service we are closing our doors," the letter read. Women who routinely walked into One Brookline Place for their annual mammogram at Boston Imaging Associates would have to go elsewhere, Team 5 Investigates' Janet Wu reported Wednesday.

In the heart of Boston's world-renowned medical hub, how could a center that did countless life-saving screenings close its doors? The truth is not what any woman wants to hear.

An analysis by Team 5 Investigates reveals that Massachusetts has fewer mammography centers per woman than any other state in New England, except Vermont. For each mammography screening machine in the state, there are 19,275 women. The ratios in other states, like Maine, are much better, but the problem is a national one.

"There's no question that access to mammography is becoming a bigger and bigger problem in the United States," said Dr. Daniel Kopans, of Massachusetts General Hospital.

Nationwide, there are 12 percent fewer offices doing mammograms compared to 1999. During that same period, New York City alone has seen 67 mammography centers close their doors.

Boston is not immune. The letter sent to patients of Boston Imaging Associates in July 2006 continued, "Unfortunately the changes occurring in the medical imaging industry have taken their toll."

It is a toll that directly impacts women's health. Every clinic that closes makes the wait time for women grow. Team 5 Investigates called every single hospital and clinic in the state that does mammography and found women have to wait an average of six weeks for an appointment. At some hospitals the first opening was five months away. That is potentially deadly news if a tumor is starting to grow inside you.

"If it becomes visible today and you can't get a mammogram for 6 months, it has 6 extra months to grow," said Kopans.

Plus, there is a shortage of radiologists to interpret the screenings. Dr. Valerie Fein-Zachary, a radiologist at Beth Israel Deaconess Medical Center, said the trend nationwide is for radiologists to choose specialties other than breast imaging. She hopes that as new, more exciting technologies including breast MRI come into play, that trend will be reversed.

"But right now we are at a point in time when we have fewer breast imagers than we need."

Dr. Elsie Levin, a radiologist who reads several hundred breast MRIs each year, adds, "Breast cancer is the number one cause of malpractice suits. There are other areas that you can have a nice life and not worry about being sued."

And then there are economics. An average mammogram costs about $125, but Medicaid has slashed its reimbursements to just $83.69, a figure private insurance companies follow. Keeping up with the latest technology doesn't come cheaply. New digital mammography machines cost $400,000. A new MRI unit costs $4 million.

"And then there's additional software, which is then about another additional $60,000," said Fein-Zachary. "Breast imaging, as a whole, is not a money maker for a hospital."

Continuing to lose money on annual mammography screenings is a financial hit that big hospitals may be able to absorb, but smaller offices cannot.

"You're pointing to a very important problem," said Dr. James Michaelson, a mathematical biologist at Massachusetts General Hospital. Mammography centers "are really struggling with short budgets."

Kopans adds, "I think it's tragic. We now have a test that has been clearly proven to save lives and it's now becoming harder and harder for women to get."