The harsh realities of mammograms

November 15, 2015

A recent poll conducted by Castlight Health reveals Miami to be the eighth most expensive city in the nation on average to get a mammogram. Among the 179 metropolitan areas surveyed, the Miami-Fort Lauderdale area resulted in an average cost of $307 for a mammogram  ranging from $96 to $510.

Pricing

Castlight Health, the company that produced the U.S. Costliest Cities Analysis revealing these statistics, provides information to businesses concerning the pricing of health care procedures.

Dallas, the city with the widest range of prices for a single mammogram, offers the procedure for anywhere between $50 and $1,045, leaving women with a tough decision on where to get their mammogram.

Two towns only miles apart can offer completely different prices for a mammogram. In New York City, facilities offer the most expensive mammograms in the nation, starting at $130 and reaching as high as $1,898; yet in Brooklyn, only 5 miles away, mammograms range from roughly $100 to $300.

According to Elsy Flores, a radiologist specialized in breast imaging in Miami, out-of-pocket prices depend largely on the facility.

“Hospitals or hospital-affiliated diagnostic centers are usually more expensive than private diagnostic facilities,” Flores said. “All private centers can set their price at what they think it’s worth but cannot be less than medicare allowable. Some centers in Miami will do a physical exam along with the mammogram.”

When health care fails to cover  mammogram screenings, the numbers add up.

“The problem is when a person without insurance needs a biopsy based on an abnormal finding. Biopsies can cost around $1,000 and if the biopsy is positive, you can imagine the cost of surgery and treatment,” Flores said.

The costs of mammograms has prompted organizations nationwide, such as the City of Miami Fire, Solid Waste, and Human Resource departments, to  make efforts to make the screenings more accessible to women. Fundraisers, such as selling breast cancer awareness t-shirts, produce the money they donate to Integris, a company that aids women over 40 in need of financial support to pay for a mammogram.

The Women’s Center for Radiology in Orlando, FL, offers “mobile mammograms,” in which a bus caters to any location with 15 or more interested patients. The women may choose to receive a screening or diagnostic 3-D mammogram for little to no cost, whereas 3-D mammograms at most centers cost an additional $50 to $100.

Risks of Early Screenings

In 2009, U.S. Preventive Services Task Force recommended that women receive their first mammogram at age 50 rather than 40. The American Cancer Society announced that they recommend women begin mammograms at age 45, beginning with annual visits and visiting less frequently the older a woman becomes without any significant issues. On the contrary, more and more women are receiving mammograms much younger, sometimes as early as their 20s and 30s.

Some women, such as Angelina Jolie, have voluntarily opted for a contralateral prophylactic mastectomy, a procedure in which one or both of a woman’s breasts are removed to prevent future risks of breast cancer. Though many women believe this procedure the “safe option,” only women containing BRCA1 and BRCA2 mutations can safely opt for this procedure due to their increased chances of inheriting breast and ovarian cancer, such as in the case of Jolie. Women without the mutations who opt for mastectomies do not decrease their chance of breast cancer, contrary to popular belief.  

For some, mastectomies come with optimism. For Vera Santos, a 38-year-old mother of four, her mastectomy limited her ability to give birth, but she appreciates the family and children she has.

“The surgery allowed me not to have kids and that’s great because I have enough,” Santos said. “I also believe that at 35 plus it’s better not to have a child because of the birth defects that could happen.”

For years, women were urged to receive surgery immediately after learning that they have breast cancer. Now, doctors and surgeons suggest that patients wait until other options surface. According to a study from the New England Journal of Medicine, hormone therapy is another valid option for those women with early stages of breast cancer, versus the harsh surgeries that often times fail to prevent further cancer from developing.

Knowing her own breast density also plays a large role in a woman’s decision to receive a mammogram, as well as to determine how old they should be when they go for their first one.

“The breasts are composed of varying amounts of fat and fibroglandular tissue,” Flores said. “In women with fatty breasts, the mammogram is most effective because fat is black on x-ray and cancers are white. In patients with dense breasts, containing mainly fibroglandular tissue, the fibroglandular tissue appears white on the x-ray and cancers are white, so cancers are harder to detect. For women with denser breasts it is recommended to combine the mammogram with ultrasound or MRI [procedures] depending on density and risk to increase our ability to detect [cancer].”

According to Flores, some states require that women know their breast density, yet Florida does not.

The Benefits of Late Treatment

Although some women rush to receive their first mammogram early in life, others simply cannot afford it, leaving undiagnosed women with the possibility of breast cancer that develops and grows over time. Without standard pricing for the procedure, in addition to possible insurance issues, women over 40 often miss out on the opportunity to nip breast cancer in the bud.

Despite age-old beliefs, factors other than getting screened “too late” contribute to breast cancer development. Recent studies prove that it is not procrastination that worsens breast cancer, but outside toxins that may cause the increase of ductal carcinoma in situ (DCIS) in women since the 1980s, a hormone indicating the earliest stage of breast cancer. Hormone-replacement therapy (not to be confused with modern hormone therapy), previously used to lessen the effects of menopause, was one such factor that caused an increase in breast cancer; once the number of women using it dropped, so did breast cancer-related deaths.

Women screened early in their lives who discover breast cancer in their bodies often pursue treatments to rid of it as quickly as possible, but at the same time, infections, radiation and chemotherapy cause detrimental effects that could have been avoided altogether.

“A patient should start screening depending on the patient’s lifetime risk,” Flores said. “If a patient’s risk is that of a 40-year-old they should begin screening at age 40 or 45 if you are following the American Cancer Society recommendations. If you are high risk (lifetime risk of 20% or greater) you should begin screening earlier. Some recommend to begin screening 10 years earlier than when your relative was diagnosed. For example, if your mother had breast cancer at age 44, you should begin at age 34.”

Although the scale may seem black and white as to when a woman should go for her first mammogram, varying degrees of lifetime risks lie in between the extreme highs and lows.

“When to begin a patient with intermediate risk is even trickier. Now who is running the patient’s risk? I find that many primary care doctors are not assessing the patient’s risk and neither do all breast centers. So, when to begin screening is very unclear for the patients,” Flores said.

With skyrocketing cases of breast cancer in younger women, doctors encourage them to wait until they are older for screenings. Yet with skyrocketing prices for a single mammogram, women of age to appropriately receive a mammogram have limited options for affordable procedures.

“In your nail polish, there’s chemicals,” senior Hailey Pablis said. “Any excess radiation from getting a mammogram I feel like is much safer than having to do chemo-treating stage five later on.”

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