Mammography utilization slows among Medicare patients

Use of breast ultrasound and breast MRI in Medicare beneficiaries has been on the rise, but mammography utilization has not kept apace. Following a big boost in the number of mammograms in the late 1990s, growth has slowed in recent years. The reason could be waning awareness of screening programs or possibly a decline in access due to center closures.

Between 1996 and 2004, the number of screening and diagnostic mammography studies rose by 45%, from 266 per 1000 women to 385 per 1000 women, according to data released by Dr. David Levin at the RSNA meeting on Monday.

However, most of the growth took place between 1996 and 2000. Utilization increased only 3% from 2000 to 2004, said Levin, a professor and chairman emeritus of radiology at Jefferson Medical College and Thomas Jefferson University in Philadelphia. In addition, the number of diagnostic mammography studies has declined, possibly due to changes in the way procedures are coded.

Mammography utilization increased sharply between 1997 and 1998, he said, due to multiple public health initiatives to increase awareness of breast cancer screening.

"After that, the rise in utilization slowed down. Between 2001 and 2004, growth was essentially flat," Levin said.

Nowadays, there are fewer public initiatives and limited access may also be an issue, he said. Reimbursement is low for mammography and the number of facilities providing it has dropped by 6% in recent years. A manpower shortage in radiology is also expected to have an impact as more women become eligible for mammography.

On the bright side, the analysis also indicates that breast ultrasound utilization rates grew strongly throughout the study period while MRI use soared in terms of relative growth, although the absolute number of studies performed is still very small.

In breast ultrasound, 15 exams were performed per 1000 women in 1996, which doubled by 2004 to about 33 per 1000 women. About one breast ultrasound exam is performed for every three diagnostic mammograms, Levin said. The rate of breast MR utilization was 0.06 per 1000 women in 1996, rising by 383% to 0.29 per 1000 women in 2004.

The analysis also shows radiologists have a dominant position in breast imaging, performing 95% of exams performed.