A 40-year-old woman walked into Elizabeth Wende Breast Care in upstate New York for her yearly screening mammogram. Although a radiologist found a nodule, the patient declined follow-up because her insurance wouldn't cover it, and she couldn't afford to pay the cost on her own.

“What do you do with that? Is there anything you can do?” said EWBC attending radiologist Dr. Stamatia Destounis.

Three weeks after the center called the insurance company, filled out forms, wrote a letter, and asked the insurance company director to review the case, the patient finally received the care she needed. The situation is indicative of the kind of environment mammographers are living in today.

The recession is affecting not only the housing, retail, and unemployment markets, but healthcare as well. What was once considered routine, preventive, and necessary is now being delayed or abandoned altogether due to money pressures.

In February the Centers for Disease Control and Prevention released a study of epidemiological data from 2000 to 2006 showing the number of women getting mammograms dropping in 34 states by as much as 5.3% (AJR 2009;192:352-360). It's easy to imagine in the current economic climate the numbers have dropped even further.

It's too soon to compile an in-depth report on how the recession is affecting mammography. But anecdotally, many mammographers are noticing a drop in patient volume. Private centers seem to be hit harder than academic centers, although a lot depends on geography. Wealthier communities will obviously be less affected than poorer ones. In the public versus private sphere, academic centers seem to be holding fairly steady or experiencing a slight increase due to the sliding-scale payment option they offer patients.

DECLINING VOLUME

At EWBC in Rochester, NY, fewer and fewer patients are returning for their yearly screening mammograms, according to Destounis.