MAMMOGRAPHY centers across the city and country are losing money and cutting services – forcing women to wait months for breast-cancer screenings and putting lives at risk, doctors told The Post.
Marie Ohanyan, 63, was infuriated when she called NYU Medical Center last May and was told she would have to wait until October for a mammography.
Diagnosed with breast cancer in 1994, she had been advised by her doctor, Gillian Newstead, to get two mammograms a year for the next six years.
“My mother died of breast cancer and I was fearful that my own cancer could recur at any time,” said Ohanyan, of Rego Park, Queens.
“I begged the center to get me an earlier appointment, but they refused. I demanded to speak to Dr. Newstead, but they forbid me to talk to her.”
Determined not to give up, she staked out the center until she spotted Newstead arriving one morning and begged for an appointment. Newstead was concerned enough to get her an immediate appointment.
“I’d never done anything so desperate before, but I was scared for my life,” Ohanyan recalled. “I’ve never had to wait more than two weeks for my mammogram.”
Her plight is not an unusual one.
“The waiting time to get a mammogram has increased at over 50 percent of radiology centers around the country in the past two years,” said Dr. Stephen Amis, radiology department chairman at Montefiore Medical Center in The Bronx.
“We can’t keep our heads in the sand any more. If this situation is not resolved soon, more and more women’s lives will be at risk.”
“Delaying the diagnosis of breast cancer results in tumors being detected at later, less treatable stages,” he said.
And the crisis is growing, as baby boomers desperately need annual screenings.
Several clinics in the city have shut down in the past two years. The most prominent closure was at NYU Medical Center, which shuttered one of its two mammography services for financial reasons in 1999.
Newstead, director of breast imaging at NYU, explained, “We just couldn’t afford it any more. We were losing money on every patient we saw.”
The mammogram, a low-dose X-ray that can detect about 90 percent of all breast cancers, has been credited with lowering the U.S. death rate from the disease by almost 20 percent over the past two decades.
The number of women aged 40 and older who have had a mammogram within the past two years has more than doubled since 1987, according to the American Cancer Society.
Last May, the American College of Radiology sent a letter to the federal government warning that more hospitals nationwide might cut back on mammography services unless reimbursement rates were increased.
The main battle is between doctors and managed-care insurers over reimbursement. Radiologists complain that the payments they receive for mammographies from managed-care companies are less than the cost of providing the test.
Doctors typically charge $75 to $150 for screening mammograms, while diagnostic mammograms, performed when a problem is suspected, cost more than $200.
But many insurance companies refuse to pay more than the recommended Medicare reimbursement rate set by Congress, which is $67 for a screening mammogram and $81 for a diagnostic exam.
“Unfortunately, those sums won’t even cover overhead costs,” said Dr. Stephen Feig, director of breast imaging at Mount Sinai Medical Center in Manhattan.
Insurers say the real culprits are inefficient doctors and clinics.
“The problem isn’t insurance coverage – the problem is many of these academic centers have no idea how to run a business efficiently,” charged Charles Cutler, chief medical officer of the American Association of Health Plans, which represents more than 1,000 managed care plans.
Another difficulty faced by mammography centers is the shortage of qualified radiologists.
Last year, for example, applications for mammography fellowships at NYU – one of the top radiology centers in the country – fell by 75 percent.
“Many would-be mammographers are choosing other, more lucrative, specialties that have a much lower risk of malpractice,” Amis said.
Doctors insist a woman with a suspicious lump can still get into the center for a mammogram quickly.
“Our waiting list may be only four months for a standard mammogram, but it is only about two or three weeks for women with abnormal lumps,” Newstead said.
But Maria Mulima, 43, said she was told she would have to wait four months before a suspicious lump could be checked out with a mammogram.
The NYU nurse called the center last April to schedule a follow-up test because her doctor had seen something unusual on a mammogram six months earlier.
To her horror, she was told the earliest appointment available was in August.
“I explained to them why I needed one so quickly and I was told the center was completely booked,” said Mulima. “I was beside myself. I’d never had to wait more than a month for a mammogram before.”
In the interim, she opted to have a procedure known as a fine-needle biopsy, where a thin needle is inserted into the lump to see if it’s a cyst or a solid, potentially cancerous, mass.
Luckily, the procedure revealed nothing more than a benign cyst, but Mulima said she was traumatized.
“What if it had been malignant?” she asked. “Four months could have made a big difference between treatment and death.”
The only way a woman can get a mammogram quickly now is if she agrees to pay up front.
Many New York radiology private practices – such as Murray Hill Radiology and Mammography – have no more than a two-week wait for a mammography if the patients pays over $200 out of pocket.
Dr. Clement Barone’s radiology office on the Upper East Side is gradually dropping insurers such as Oxford Health Plans and Aetna U.S. Healthcare.
“I’m near the end of my rope with all the major insurance companies,” said Barone, whose office does more than 8,000 mammograms a year. “It’s got to the point where I feel that I am doing pro bono work for them.”
Private offices like Barone’s, which charge patients full out-of-pocket fees, are able to expand their facilities and buy the latest equipment, which often provides sharper X-ray images than standard mammograms.
New York doctors and breast-cancer crusaders are asking women to lobby their Congressional representatives to raise the recommended Medicare reimbursement rates for mammograms.
“If Congress does set a higher rate, there will be a lot of pressure put on insurance companies to follow suit,” said Amy Langer, executive director of the National Alliance of Breast Cancer Organizations, a nonprofit education and information resource on breast cancer.
In the meantime, Langer urges women to make mammogram appointments six months in advance.
“Women need to know it’s more important to get that appointment late than not at all, preferably at the same center,” she said.
Ohanyan has already made her appointment for next year .
“It makes me angry that we have to do that, but we shouldn’t be taking any chances,” the Forest Hills resident declared.