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When the pink dominoes start to fall

Nov 12, 2007 | Monique Doyle Spencer | Boston Local News

The last pink ribbon has been sold. Another Breast Cancer Awareness Month is over.

So now you'll call and book your mammogram for next week, right? Oh, dear. The first appointment is in December? January? February? You hang up. You'll do it again next year. You'll try to remember to call on your birthday. You'll forget, until it's the month of pink again, next October.

Why? Because we are dumb as dirt. We march, we pin ribbons, we buy anything from anyone who will give a percentage to breast cancer research. And guess what? While we are selling bracelets, the government is leading the charge to destroy the mammography field. Mammography is a faltering field in crisis. Breast Cancer Awareness Month is like spending a zillion dollars on an ad campaign to sell a car you haven't made yet.

See, the government sets reimbursement rates for Medicare, and that's when the pink dominoes start to fall. Insurance companies like to use those numbers to prove that their numbers make sense. And guess what Medicare pays for your lifesaving mammogram? $83.69.

Now, count how long your mammogram takes. Add in the salary of the technician who does it for you. Take a look at the high-tech squisher, which must carry a NASA kind of price tag. Now try to find a talented radiologist who will choose the lowest paying field to go into, one that has the highest rates of litigation.

I don't think $83.69 covers it. So? So lots of people want to get out of the field. There are fewer places to get a mammogram now than there were before we started marching. Seriously: mammography clinics are closing.

And, by the way, you like to think that a mammogram is like an X-ray, which will show whether that bone is your arm or your leg. In reality, mammography is more like finding a contact lens in a swimming pool. It takes talent. It needs radiologists. Thank God people are still going into this field. But ask around at your hospital, where they have the hardest time finding people. I bet they get more applicants for bedpan work than mammography. The bedpan may pay less, but you can skip medical school and the hours are way better.

If you go to see a psychiatrist just once, Medicare will reimburse the doctor about the cost of a mammogram. I wonder how many women with breast cancer end up in therapy; I think it's what statisticians would call a whole bunch. But to Medicare, a mammogram equals one hour of therapy. I like psychiatrists, I just think mammography machines cost a little more than comfortable furniture does.

Plus, we like to sue mammographers. Even though we know it's not a perfect science, we go after them in court at record rates, and we win.

My first round of breast cancer was lobular, a type that is impossible to see on a mammogram. By the time it was diagnosed, it was kind of far along. While lying down in the CT scan machine to find out whether it had spread anywhere else, the technician told me that I should sue the hospital for malpractice.

"You'd win," she said. "You went every year and they never found it and it's huge." But it's lobular, I said. "You'd never have to work again," she replied.

As a writer, I don't actually work anyway, so this had little appeal. I told her that if I believed this hospital could have found my cancer sooner, why the heck would I be seeing her? We've crossed so many frontiers in breast cancer for white women with health insurance. Most survive breast cancer because they find it early. But guess what, girls? It's going to get more difficult to get in for your appointment, even when you have a lump. That's right - find a lump, wait a month. For that we marched? And shopped?

So how about it, senators? Congressmen and women? Pay for mammography if you really want to curtail advanced breast cancer. Encourage young doctors to go into the field. Bring more mammography clinics to the poor, not fewer.

Pass a bill, dear Congress, and we promise: you don't have to remember to pin on a pink ribbon next October.