Regardless of the ultimate outcome on federal mammogram guidelines, November”™s uproar on the topic made one thing clear: As broader health reform moves forward, some health-care businesses could find peril in directives emanating from the federal and state level.
In mid-November, the U.S. Preventative Services Task Force altered previous guidelines calling for women between the ages of 40 and 49 to receive biennial mammograms on a routine basis, save in cases where women face higher risks of developing breast cancer. Part of the U.S. Department of Health and Human Services, the task force also said there is no evidence that routine mammograms are necessary for women 75 or older.
The new guidelines set off protests both from women who cited routine tests as likely saving their lives, as well as physicians providing screening services. Only in October, Gov. M. Jodi Rell urged women over the age of 40 to get tested, with Rell herself a breast cancer survivor after being diagnosed five years ago.
According to the Department of Public Health (DPH), more than 550 women in Connecticut died of breast cancer in 2004, the most recent year it has published statistics on the disease”™s mortality rate. The state has the third-highest incidence rate of new cases of breast cancer annually among the 50 states, though only the 26th highest mortality rate.
DPH cites early detection through breast cancer screening for a declining death rate the past three decades.
Under a state law passed in 2001, insurance carriers must cover annual mammograms for women aged 40 and older as well as a diagnostic “baseline” mammogram for women between the ages of 35 and 39.
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That has resulted in a proliferation of clinics to provide screening services, more than 25 in Fairfield County alone including those operated by the county”™s six acute-care hospitals.
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Stratford-based Robert D. Russo M.D. and Associates Radiology operates six clinics in Fairfield County that employ more than 100 people, and Trumbull-based Advanced Radiology Associates has seven centers.
Dr. Robert Russo estimates his clinic would lose at least 15 percent of its volume, if the federal government enacted the guidelines promulgated by the task force. Russo”™s clinics perform some 30,000 mammography procedures annually, accounting for about a third of the company”™s business; it also performs CT scans and magnetic resonance imaging tests, among other services.
“We”™re all kind of stunned from our side,” Russo said. “I think everybody is just holding their breath.”
The past few years, some proponents have been pushing for the state to expand the law to cover ultrasound exams for women with dense breast tissue, whose precancerous conditions can sometimes be missed by regular mammograms. Performing ultrasound exams, Charlotte Hungerford Hospital in Torrington caught between five and 10 cases in which normal mammograms failed to catch the early signs of breast cancer.
“The trials show that a breast ultrasound does find cancers not spotted by a mammogram, particularly for women who have dense breasts,” said Linda Kowalski, executive director of the Radiological Society of Connecticut, testifying in support of ultrasounds earlier this year to a committee of the Connecticut General Assembly. “The flip side is that ultrasound is such a sensitive technology. It can find a problem that leads to a biopsy and it could turn out to be nothing serious.”
