| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Commentary |
1 Department of Radiology, University of Michigan, 1500 E Medical Center Dr., Ann Arbor, MI 48109-0030.
Received August 21, 2008; accepted after revision August 25, 2008.
Address correspondence to R. C. Carlos.
Keywords: mammography • screening
Breast cancer screening by mammography has declined [1–3] despite a clear reduction in mortality attributable to screening [4, 5]. Multiple factors likely contribute to this decline, including decreasing rates of health insurance coverage, increasing copayments, expansion of high-deductible health plans and self-managed health reimbursement accounts, de-emphasis on breast cancer screening in health campaigns, and campaign fatigue from the proliferation of preventive health behaviors being recommended. Access issues often focus on the availability of financial resources to pay for health care and less frequently relate to system capacity and service availability.
Radiology technologists and radiologists who provide mammographic services have experienced the effect of declining numbers of patients. Reductions in the workforce that provides these services—manifested as fewer accredited centers, shorter hours of operation, and elimination of mammography as a service offered by a given practice—contribute to limitation of access. An Institute of Medicine report [6] posited that these declines in capacity potentially contribute in no small part to the declining rates of mammography. Furthermore, workforce short ages are likely to disproportionately affect underserved populations, such as urban poor and minority communities. The consequences of less screening are increases in the incidence of invasive cancer detected and in breast cancer mortality.
The decline in screening mammography rates may be felt beyond the woman who forgoes screening. Social learning theory holds that health behaviors and attitudes toward preventive care are learned, both within the family and in the community at large [7]. Fewer women undergoing screening means fewer models for appropriate preventive behavior by their children. Once learned, health behavior is difficult to change. Could this decline in screening rates be propagated across generations, reversing the gains made over 20 years? In addition, declining mammography rates may lead to relaxation of social norms of preventive behavior, potentially increasing the individual's perception that screening mammography is not an essential procedure.
The impact on future health behavior can extend to lost opportunities for prevention of cervical cancer. The use of maternal screening mammography as a teachable moment, or educational opportunity, is being actively studied to improve parents' education about use of the human papillomavirus vaccine by their daughters. If this parental education is found effective in increasing the rate of human papillomavirus vaccination, screening mammography may help reduce cervical cancer rates in the next generation, extending its value beyond the direct effect on reducing breast cancer mortality.
The impact of workforce reductions is felt viscerally by providers of radiologic services. Beyond the reading room, this reduction has the potential to affect not only women currently or soon to be eligible for screening but also the next generation.
References
40 years: United States, 2000–2005. Morb
Mortal Wkly Rep 2007; 56:49
–51[Medline]
CiteULike 
Complore 
Connotea 
Del.icio.us 
Digg 
Reddit 
Technorati What's this?
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
