Experts discuss barricades in breast cancer screening

Oct. 29—As a radiation oncologist at Community Howard Regional Health, Samantha Buszek said she's seen firsthand what happens when breast cancer isn't detected early. As a result, she tells her family members to get annual screening mammograms once they turn 40.

However, she pointed out, different organizations have conflicting guidelines for women. One organization might recommend a screening every few years while another might stress annual screenings. Or, an organization might say people should wait until their 50s to begin screenings.

Although there are good reasons for the discrepancies between guidelines, Buszek said, the conflicting information might lead some patients to miss early cancer detection.

The radiation oncologist said other factors such as financial burdens, access to primary care physicians and underestimating the importance of screening could delay a patient's detection of breast cancer.

Explaining the discrepancies between screening recommendations, Buszek said population medicine researchers try to reduce the strain on medical institutions while accounting for the risks patients face.

Individual experiences with cancer are different from an entire population's experience with cancer, Buszek said.

"If you recommend a test to an entire population, how many people do you have to test before you find breast cancer?" Buszek asked. "How many biopsies are done that aren't actually needed?"

Stressing the importance

Detecting breast cancer at earlier stages means doctors have a higher chance of curing the disease, Buszek explained. She added the treatment is usually less invasive and some patients are able to avoid chemotherapy.

"It's a very low-risk procedure that has the ability to identify a much earlier stage and less aggressive breast cancer than you would typically be able to find if you waited until you could feel a lump in your breast," Buszek said.

Holly Pratt, lead mammography technologist at Kokomo's Advanced Medical Imaging office, mirrored Buszek's sentiments.

Some patients, she said, don't consider screening mammograms because their family doesn't have a history of breast cancer, or they assume self examinations recommended by the American Cancer Society will catch lumps early enough.

"A mammogram can pick up something that's so small, you're not going to feel it for maybe a year," Pratt said.

While it is possible for males to get breast cancer, Pratt said, annual screenings aren't necessary. Instead, males who detect a change in their breast or have a family history of breast cancer should consult a primary care physician before ordering a screening.

Scott Morrow, administrator at AMI Kokomo, noted that it can be difficult to fit cancer screenings in a busy schedule. Although the procedure doesn't take long, people working full time might not schedule mammograms as often as they should.

"You just kind of put it off, and then all of a sudden here, it's been two or three years," Morrow said.

While mammograms aren't the only form of breast cancer screening, Pratt explained, they are considered to be the "gold standard."

"If you're only going to pick one thing, that's the most effective," Pratt said.

Financial barricades

Morrow explained service rates are negotiated with insurance companies. Before setting a contract, he makes sure AMI is able to pay staff members and maintain or upgrade technology.

Out of pocket payments are based on the insurance rates.

"Contracted rates for mammograms could be anywhere from $200 up to $800 through insurance based off of those negotiated rates," Morrow said. "Typically as a business, we take those rates and then figure out a good price point for a self pay rate."

At AMI Kokomo, he said, the self-pay rate for a screening mammogram is $187 while the contracted rates usually sit around $200.

Although many insurance companies will cover the full cost of an annual screening mammogram, some patients are recommended additional screening procedures or mammograms that require payment.

For example, Pratt explained, 40% of women have dense breast tissue, which can make suspicious lumps difficult to detect in a mammogram. In those cases, a radiologist might recommend an MRI or an automated breast ultrasound.

"We've experienced people that have told us that they couldn't go on with it because they couldn't afford that out of pocket cost for that additional screening," Morrow said in a previous interview.

People without insurance have to pay for breast cancer screening on their own, he added.

The automated ultrasounds, Morrow noted, are able to be used for cancer screening as well. However, the procedure must be ordered by a primary care physician, while mammograms don't.

Another doctor

"All the tests we do here require a written order from the doctor except the screening mammogram. It's the one and only thing," Morrow said. "Indiana changed the law several years ago because it's so important."

AMI still requires patients to list a primary care physician, though. If screening results show a suspicious lump, the imaging center makes sure a physician is able to follow up with the patient.

Buszek noted that establishing care with a primary care physician can present an additional challenge to some patients.

"It's hard to get the time off work," Buszek said. "Usually, it's a couple of months out before you can get your appointment. And then you have to go see them. And then they would order your mammogram for you. And then you have to leave work again."

Attempts to reduce financial barriers

Leading up to October, which is breast cancer awareness month, AMI organized its first major fundraising event.

The Medical Imaging location had held one smaller fundraiser the previous year, a ladies shopping night, before its building burned down. When it was re-established in a new building roughly three months later, employees started thinking about ways they could make a bigger impact.

After months of planning, the Breast in Show fundraiser was held Sept. 30 in the Kokomo country club. The sold-out fundraiser raised approximately $20,000 to cover breast cancer screening costs for people who don't have health insurance.

If the benefactors are only going to get mammograms, Morrow said, up to 200 people could be helped.

Joni deLon, a volunteer for the fundraiser's fashion show, said she signed up to help after being recommended a follow-up mammogram. The model said she was thankful that she could afford the follow-up, but recognized the cost could turn other people away.

To draw attention to the available funds, some of the fundraiser donations will be put toward free mammograms held in AMI Kokomo, 2008 W. Boulevard St., on Dec. 7 and 20.

Although the facility will accept walk-ins on those days, Morrow said scheduled appointments are preferred. To schedule an appointment, call 765-454-9729.

AMI also plans to make the funds available year-round.

"The ultimate goal, obviously, was to raise some money to be able to help folks that couldn't afford breast imaging," Morrow said before the fundraiser. "We see it every day."

Community Howard Regional Health tries to address financial barriers to breast cancer screening with a dedicated fund.

"Thankfully, insurance covers screening mammograms," George Mast, marketing and communications director for the hospital, wrote in an email. "The fund helps out for women who do not have insurance, or who might be underinsured and need help with a diagnostic mammogram (which is different than a yearly screening mammogram)."

The fund, he explained, covers a variety of issues, such as transportation and testing. Patients are able to apply for assistance by contacting the Community Howard Women's Center.

James Bennett III can be reached at 765-454-8580 or james.bennett@kokomotribune.com.