Mammographer shortage fails to subside

As more women in the U.S. turn to mammography to detect breast cancer, the availability of mammographers and technologists certified for breast imaging is decreasing, according to a survey published in the May issue of Radiology.

The survey questioned 45 mammography facilities: 45% reported a shortage of radiologists, and 20% noted unfilled technologist positions. Almost half said they were having difficulty maintaining an adequate staffing level of technologists certified under the Mammography Qualified Standards Act (MSQA).

Shortages were greater at nonprofit facilities than for-profit operations. The results were based on responses from mammography facilities surveyed in 2001-2002 in Washington, New Hampshire, and Colorado.

Facilities reported long waiting times for women seeking screening mammography. While 85% of respondents scheduled diagnostic mammography within one week of a patient's request, only 13% scheduled screening mammography that quickly.

In fact, 11% reported that women had to wait four to eight weeks for screening mammography. Appointment waiting times grew longer as volumes of exams performed at a site rose.

Staffing shortages contribute to the problem, according to lead author Dr. Carl D'Orsi, director of the Breast Imaging Center at Emory University in Atlanta.

"If we do not address staffing shortages, more facilities will close, making screening and diagnostic imaging impossible for some women," D'Orsi said.

In addition, relying on fewer personnel to interpret mammograms may affect the accuracy of diagnoses, he said.

D'Orsi and colleagues point to decreasing financial compensation and rising malpractice litigation as possible causes for declining interest in mammography.

"Radiologists are being hit with lawsuits. One of the most common reasons for a medical legal allegation is failure to detect cancer, with breast cancer being the most common," said coauthor Dr. Joan Elmore. "Interpreting screening mammograms is simply not a moneymaker. Reimbursement set by Medicare is low, and many facilities feel they are losing money."

Another disincentive to pursuing a career in mammography may be strict MQSA measures, including increased education requirements and the burden of tracking biopsy yield at each facility.

"The amount of paperwork that facilities need to undertake regarding mammography is daunting," Elmore said. "Congress is reevaluating MQSA requirements now. Obviously, we want to maintain high quality for breast imaging, but with this study, we wanted to hypothesize why there may be a personnel shortage and initiate discussion of ways we can improve quality."

For more information from the Diagnostic Imaging archives:

Breast centers tune up for peak performance

Closing doors in mammography threaten continued access to care

3T breast MR heightens speed and spatial detail

Breast tomosynthesis trials show promise