A state group studying cancer trends is trying to remove one of the biggest excuses women have for not getting mammograms -- the high cost.
Carroll County General Hospital is not taking part in the program, however. The hospital already has relatively low mammogram costs,said Kenneth W. Geiger, administrative director of radiology. Also, the hospital expects to perform about 4,500 mammograms by the end of 1991, which is about as many as it can handle with the current staff and equipment, Geiger said.
Westminster radiologist Dr. Edward Carter said low-cost mass screening programs often mean the patient has to come back, at an additional charge, because the first mammogram wasn't thorough enough.
"Plus the worry, the anguish, is a problem, too," Carter said, when a woman has to make a second appointment to find out what she could have during the first visit.
"Obviously, you would like to have a cheap way to get people through the system, but it takes some time," he said, for a radiologist to read the film.
The cost of a mammogram can even deter a woman who already has a lump on her breast.
Despite a lump and pain, Ellen, a 23-year-old Westminster woman, delayed getting a mammogram because she didn't have the money, she said. She said she had found out it would cost her just over $100 at CCGH, and she didn't want to go until she knew she could pay for it.
"It would just be a bill that was hanging over your head," she said.
Ellen, who asked that her last name not be used, said she has no health insurance. Her husband, a construction worker, makes just over the limit for qualifying for Medicaid, which would have paid for her mammogram. While visiting the Health Department for care for her two small children, she found a nurse there who helped by getting emergency moneyfor the mammogram.
In addition to the mammogram, Ellen is to havean ultrasound test to find out more about the lump, she said.
Among the different kinds of cancers that affect women, breast cancer isthe second most common killer -- lung cancer recently became No. 1, said Paul Averill, program director of the Maryland Cancer Consortium, a part of the Department of Health and Mental Hygiene.
That's why the consortium this year began spearheading a program urging hospitals to offer low-cost screening mammograms of $45 or less, including the cost of a radiologist to read the results.
To subsidize this, the Maryland Health Services Cost Review Commission would allow hospitals to increase their rates for all other hospital procedures. The commission also would have allowed hospitals discretion in setting up income eligibility guidelines for who would qualify for the mammograms, Averill said.
Carroll County General's minimum cost for a mammogram is $59, plus about $50 for the radiologist -- a physician who reads the film and determines whether it shows any suspicious masses that need further testing, such as with ultrasound or biopsy.
Hanover (Pa.) General Hospital has its own low-cost screening mammogram for$59, including the radiologist's fee, said Kathy Melching, administrative director for radiology.
The Johns Hopkins Hospital in Baltimore is one of the more expensive in the state, starting at $120 for the mammogram and another $46 for the radiologist to read it, said Michael Reese, technical manager in radiology.
But he said the hospital is considering participating in the low-cost program, and developing a faster screening procedure in which a few shots of the breast are taken, and the patient goes home before a radiologist reads them. Only those with suspicious masses would be called back for further mammography.
Reese said most of the 6,000 mammograms a year performedat the hospital now are not screenings, but diagnostic procedures for women who already have some sign they might have breast cancer, Reese said. As at CCGH, the women wait for the radiologist to read the films before they leave, in case additional shots are needed.
Reesesaid Hopkins' cost to provide a mammogram is at least $50 for supplies and staff salaries. The figure does not include depreciation of the equipment or overhead, he said. CCGH and Hanover General were unable to compute their actual costs for providing a mammogram, but Cartersaid national studies have shown it costs at least $40 on the average.
The closest hospitals that participate in the low-cost program are in Baltimore -- Maryland General Hospital, Bon Secours Hospital, Harbor Hospital and the University of Maryland Hospital. Another 15 have expressed interest, Averill said.
Averill said the consortium thinks the plan is worth subsidizing with other services because it can make a difference. Also, he said, hospitals already routinely subsidize some money-losing services with others that make money, so why not for mammograms?
"It's been clinically proven that early detection through mammography reduces breast cancer mortality by 25 to 30 percent," Averill said.
Carroll County's death rate from breast cancer is higher than the national average, and just below the state figure. In Carroll, the annual death rate from breast cancer is 29.2 of every 100,000 women, compared to 27.2 nationally and 29.9 for Maryland.
Geiger said the hospital performed 3,000 mammograms in 1987 and 1988, 3,500 in 1990. Based on statistics so far this year, he expects to have performed 4,500 by Dec. 31.
So far, it takes about one to two weeks to get an appointment, he said. A woman would need to schedule about an hour for the procedure, including registration and waiting time.
A radiologist will read the film while the woman is still there, in case she needs to be photographed again from another angle, Carter said.
The American Cancer Society recommends that women get a first mammogram at age 35 if they have a history of breast cancer in the family, or at least by age 39. After age 40, the society recommends a mammogram at least every two years, and after age 50, every year.
COSTS FOR MAMMOGRAPHY AND READING
* Carroll County General Hospital, Westminster -- $109
* Med-Care Imaging, Westminster-- $102
* Johns Hopkins Hospital, Baltimore -- $166
* Hanover (Pa.) General Hospital -- $59 for a screening only
Note: Most charges (rates are approximate minimums) covered by Medicare and Medicaid; insurance and HMO coverages vary.
SOURCE: Respective institutions