At the Wichita Clinic in Kansas, mammogram parties come complete with chocolate fondue, massages and beauty consultations. In Seattle, making a "mammogram promise" means ladies can win a special votive candle or larger prizes. And in St. Louis and Chicago, mammogram incentives range from wine, cheese and roses to weekend spa-getaway packages.
In the past, women have been told to get a yearly mammogram screening beginning at age 40 and to perform breast self-exams.
Last fall, experts with the U.S. Preventive Services Task Force recommended that screening mammograms be done every two years rather than every year, and beginning at age 50 rather than 40. The task force also found "insufficient evidence" that mammogram screening is effective for women over age 75 and recommended against breast self-exams for all women.
Because there's no evidence showing that screening women in their 40s decreases mortality rates, the revised guidelines could reduce the risk of false-positive results that lead to unneeded breast biopsies, chemotherapy treatment and accompanying anxiety, the task force said.
Though the task force later clarified that the decision to get a screening before age 50 should be based on individual factors, the guidelines were strongly criticized by some physicians, advocacy groups and lawmakers. The American Cancer Society, the American College of Radiology and many physicians still recommend mammograms starting at age 40 and breast self-exams for all women.
The new recommendations "allowed women to cancel (appointments), and I don't think that's a very good thing," said Dr. Eleanor M. Walker, director of breast radiation oncology at Henry Ford Hospital in Detroit.
Luring women back
Hospitals are working to make mammograms more convenient and recast the uncomfortable procedure as something fun to do with friends and family members. At St. John's Mercy Medical Center in St. Louis, the decision to have a mammogram is still left up to a woman and her doctor.
But the hospital has launched some creative promotional events, including Mamm & Glam, which allowed women to tour a digital mammogram van parked in a busy area of a local mall. It also hosted a "Ladies Night Out" which offered mammograms in a spalike setting that included back massages, hair and makeup consultations and makeup sessions.
About 350 women went to the event, which was also a chance to preview a new medical building. More than 60 had mammograms, and officials are considering hosting it again.
"We've tried to make what could seem like another appointment for a busy woman a little more appealing," said Barbara Meyer, regional vice president of communication and marketing for St. John's Mercy.
Other providers are using social media to reach women. Henry Ford Hospital, which gives women a pink carnation when they come in for their appointment, developed a Facebook application called Pinky Swear. It allows women to send an e-mail to friends asking them to "make a promise" to get a mammogram and makes it possible to schedule the appointment online.
In Arizona, Scottsdale Medical Imaging started a consumer-friendly Web site (getamammo.com) and launched an ad campaign targeting women in their 40s. The center links up with journalists who use Facebook and Twitter, asking them to spread its message, and also attends community and employer-based health fairs.
"Our message hasn't changed; what's different is how we distribute it and get people engaged," said Shannon Barrow, SMI's director of marketing. Medical-imaging providers traditionally have worked with medical practices. But now they're marketing directly to consumers "because patients have a choice and a lack of understanding about how and when they need to get the exams done," said Barrow.
At the Moffitt Cancer Center in Tampa, Fla., mammogram volume is down about 15 percent to 20 percent. Last year at this time, Moffitt couldn't take new patients; appointments were booked three months out. Today there's a 24-hour turnaround.
For the first time since 2002, Moffitt is marketing mammograms. But rather than offering incentives, it's partnering with the regional transportation program and church groups to reach high-risk groups, including African-American women, who are more likely to be diagnosed at a younger age with a more aggressive cancer.
Moffitt is also considering setting up seminars to help doctors better understand the new guidelines. Simply inviting women to "mammogram parties," could send the wrong message, said Lynne Hildreth, department administrator of women's oncology at Moffitt.
"Mammograms are a medical test, and to treat it like a haircut overlooks that there are very real risks," said Hildreth. "It's not the same risk as getting hit by a car, but there's a real risk of getting a false positive, which means a biopsy work-up, time off work, sleepless nights waiting for test results and a nagging in the back of the mind that never goes away. If we put a woman through that with no medical basis, it's irresponsible."