HSA members question changes to screening mammography guidelines

The Report: September 1998 vol.19 num.2


Recent changes to the Screening Mammography Program of BC have raisedconcerns among many HSA members. As a union, HSA has a unique perspective on the changes;not only is the unions membership 90 per cent female, but HSA represents themammographers who provide this important service on a daily basis.

At the recent HSA annual convention, delegates passed a resolutioncalling on the provincial government to -reinstate screening mammography as aprocedure to be available at publicly funded union facilities." Delegates also raisedthe issue during a question-and-answer period with Health Minister Penny Priddy.

HSA Vice-President Kelly Finlayson, a mammographer at St. JosephsHospital in Comox, says the screening mammography program is sorely underfunded. This ishaving a negative impact on accessibility, cost-effectiveness and quality of care.

-Earlier this year, the SMPBC announced it will no longerregularly screen women between the ages of 40 and 50," explains Finlayson. -Andfor women over 50, the program has moved from annual screening to once every twoyears." Some say the changes make sense because they allow the SMPBC to target morewomen over 50, among whom the incidence of breast cancer is higher but often lessaggressive than breast cancer found in women under 50. However, Finlayson says she isworried these changes have less to do with good health care and more to do with limitedbudgets.

Finlayson says the program has made some positive changes over the pastyear, including the designation of several hospitals as -ancillary centres"which will allow them to screen women as well as provide diagnostic mammograms. Untilrecently, mammography departments at acute-care hospitals were not funded to providescreening because the service had been turned over to the mobile vans run out of privateradiological clinics. Hospitals were only funded to provide diagnostic mammograms whichmeant the equipment sat idle while many women waited for the mobile vans to visit theircommunity.

Another HSA member who has lobbied hard for better access to screeningmammography is Brenda Munro, chief steward and a mammographer at West Coast GeneralHospital in Port Alberni. In her community, women were waiting up to six months for anappointment with the mobile van. Munro also discovered that since the hospital had stoppedperforming screening, eight per cent fewer women were getting mammograms.

When Munro learned the SMPBC was setting up ancillary centres in Comoxand Campbell River, she gathered 1,800 signatures on a petition. Earlier this summer, herefforts paid off when she learned that West Coast General had been approved to apply forancillary status. Munro says she expects the application will be successful and women inher community will be able to access screening mammography at the hospital by September.

Still, Finlayson says establishing ancillary centres is only part ofthe answer. At her hospital in Comox, Finlayson is capped at 3,000 screens per year. Basedon the population of the Comox Valley, she estimates the program is reaching only 38 percent of the women who should be getting regular mammograms.

After a woman is screened in Comox, the film is sent to Nanaimo to bereviewed by a radiologist because it is the nearest -reading centre." If thereading centre radiologist detects an abnormality, the film is then sent back to theradiologist in Comox who notifies the woman and her family doctor that diagnosticmammography follow-up is recommended. Finlayson says the time it takes for a woman tolearn the results of her mammogram is lengthened by sending the films to Nanaimo.

The cost associated with establishing more ancillary centres and more-reading centres" could be absorbed if other parts of the program were moreefficient. Finlayson points to the policy of the SMPBC which says if a woman is unable toaccess the breast screening program in a reasonable time frame (less than two months) dueto lengthy wait lists or limited visits from the mobile van, she can get a mammogram onrequisition from her doctor (the screening mammography program does not normally require aphysician referral). However, even though the woman is receiving a screening mammogram,the Medical Services Plan requires that it be billed as a diagnostic mammogram at a costof $73.66. A screening mammogram costs $28.50. Its the same examination, same views,same equipment, same film, same technologists ... but costs the system far more.

-A rough statistical survey at my hospital suggests since April 1,1998, about 32 per cent of the mammograms performed in our department have actually beenscreening mammograms," says Finlayson. -But they were billed as diagnosticmammograms. If this problem was rectified, imagine the savings that could be reinvested toexpand the program and possibly save more lives." Finlayson estimates that, at herhospital alone, the savings could increase the number of screens by 1,500 per year.

In addition to concerns about access and cost-effectiveness, Finlaysonand her colleagues worry about quality of care. With the increase in private providers,she fears women may not be receiving the time and attention they need. The SMPBC says onetechnologist can safely perform a maximum of 25 screens per day (one client booked every10 minutes). But Finlayson says she knows of private clinics where two technologistsperform a combined total of 55 or 65 cases per day, far exceeding the SMPBC guidelines.

-Mammographers from around the province have contacted me toexpress their concerns about the service we are providing," says Finlayson.-When there isnt adequate time to see clients and answer their questions, weare not providing the best care to women."

Finlayson had an opportunity to outline HSAs concerns in moredetail at a recent meeting with Health Minister Penny Priddy. -The minister was verywell-informed about the screening mammography program but wasnt aware of some of theproblems we identified," says Finlayson. -I felt she was very receptive. Sheasked pertinent questions and promised to investigate our concerns."

Finlayson says she will follow up with the ministers office inearly fall. She hopes the perspective she is able to share as a mammographer may go someway toward improving the service for women in her community and around the province.