"As More Women Seek Mammograms, Many Have to Wait Months".

Low Payments From Insurers, Influx of Patients Put Breast Clinics in a Bind.

"Last year the NYU-Zuckerman Breast Imaging Center in New York performed 50 mammograms a day, scanning women for breast tumors too small to be detected by touch. This year, it's out of business.

"We couln't do it anymore," says Gillian Newstead, the center's former chief radiologist. "We were losing money on every patient that came through the door". And the center's patient load was rising.

Across the nation, record numbers of women over age 39 have been heeding the advice of public-health experts to get an annual mammogram. Though ultrasound scans are sometimes prescribed for women with known breast abnormalities, mammograms are considered the best early detection tool for breast cancer in most women. The test, a low-dose X-ray that can detect about 90% of all breast cancers, has been credited with helping to reduce the U.S. death rate from the disease by an average 1.7% a year over the past decade.

But rather than expanding or building new facilities to meet the growing demand, some radiologists and imaging centers are shutting down their mammography practices as money-losing businesses. Others that have stayed open are so overwhelmed that even high-risk patients may face potentially dangerous waits for appointments.

Underlying the crunch is a little-noticed feud between doctors and managed-care insurers over reimbursements for the tests. Radiologists complain that the payments they receive for mammographies have stagnated or even declined over the past several years as managed care has captured a larger share of the U.S. health-insurance market. They say that's partly because they have had to accept fees from managed-care plans that sometimes are less than the cost of providing the test. The managed-care companies argue that their reimbursement are appropriate and say that the real problem may be inefficient doctors and clinics.

No matter who's right, the upshot is indisputable: American women's ready access to breast-cancer screening is being compromised.

Dr. Newstead, who currently runs the breast-imaging program at the New York University Medical Center, says it is becoming increasingly difficult to keep pace with the demands for appointments there. Contributing to the logjam, she says, is an influx of patients from other facilities in the city that have dropped out of those patients' managed-care plans."