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Healthcare Upside/Down: Increasing and Improving Access to Mammography Screening

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ECG’s radio show and podcast, Healthcare Upside Down, offers unfiltered perspectives on what’s working in US healthcare and what’s not. Hosted by ECG principal Dr. Nick van Terheyden, each episode features guest panelists who explore the upsides and downsides of healthcare in the US—and how to make the system work for everyone.

October is Breast Cancer Awareness Month, and this episode of Healthcare Upside Down focuses partly on the history of breast cancer screening.

Joining us on episode 47 of Healthcare Upside Down is Don Lavanty, Professor at Marymount University and Principal at the Federal Group, and Jessica Turgon, Principal at ECG Management Consultants and leader of the firm’s oncology service line.

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The origin of mammography—the specialized X-ray imaging of breast tissue using a low dose of radiation—is interesting. The concept originated with German surgeon Albert Salomon, who imaged 3,000 mastectomies in 1913, but the true clinical use of the technique didn’t occur until after a 1966 study was published by American radiologist and mammography pioneer, Dr. Philip Strax, demonstrating that early detection significantly reduced the breast cancer mortality rate. He was spurred into a single-minded battle against breast cancer in 1947 when his first wife died of the disease.

But making the screening available to the widest number of people possible took much longer. It was not until legislation was changed and screening became a covered offering for the general public that uptake of mammography started to increase. Currently, around 70% of women over the age of 40 are getting mammograms, but racial and economic divides continue to negatively impact outcomes for a group already suffering a larger burden of this disease.

Don Lavanty is a principal at the Federal Group and a professor at Marymount University. In the 1980s, he helped the American College of Radiology lobby Congress for expanded coverage of breast cancer screening. Jessica Turgon is a partner with ECG Management Consultants and the leader of the firm’s Oncology Services practice. On episode 47 of Healthcare Upside Down, they talk about the progress that’s been made in the early detection of breast cancer and how we can overcome the barriers to screening for the second-leading cause of cancer death in women. Below are a few excerpts.

The expansion of mammography.

Don Lavanty: “The American College of Radiology came up with an accreditation program, and with the American Cancer Society, they took the lead on doing more for breast screening. It wasn’t until the late 1980s that you started getting screening programs [covered under Medicare]. You always paid after the fact for a disease. It was totally different for Medicare to pay upfront before a condition had occurred. So they commissioned me to go to the Congress. We worked with Senator Brock Adams, the Breast Cancer Coalition, the Komen Foundation, and Senator [Barbara Ann] Mikulski, who was really an advocate for women’s health, to get a qualified process in place.”

Jessica Turgon: “I really love Don’s story, because it wasn’t that long ago that we didn’t have access to mammography. My generation takes for granted that it will be there and will be covered by our insurance. As programs expanded, people were able to catch cancer earlier in the diagnosis and get treated, and then be able to go on with their life. The impact on women living through a cancer diagnosis has been significant. Of course, a lot of this depends on where you live, what type of resources you have, and all the socioeconomic challenges that go along with current healthcare in our environment. But getting [mammography] covered was significant for cancer care in the US.”

Cost, fragmentation, and politics limit access.

Don Lavanty: “The American healthcare system was $45 billion in 1965. Now it’s in the trillions, you’re trying to expand services, and you have a budget restoration process in the Congress where the tax dollars are not sufficient. Congress has to decide where the dollars go. Is it breast cancer? Children’s brain surgery? This is a very difficult thing. And the United States will never solve that problem, in my opinion. As long as we have this two-party system, we have to find a way to make both of them work together.”

Jessica Turgon: “As a consumer, you’re trying to make the best choice, and you’re listening to your healthcare provider, who’s trying to navigate you through a complex system. But maybe that healthcare provider doesn’t have all the information. As a woman who’s had to navigate care, from a personal level, it’s challenging. To Don’s point, it’s a significantly fragmented system that often is not engineered toward what’s best for the patient.”

Can new technology help improve access to screening?

Jessica Turgon: “Until we change how a mammogram is delivered, we are beholden to the technology. We can speed up the access point, think through various ways to engage with patients to facilitate reminders, make sure the right type of connections are made between a woman’s care provider and the radiologist, etc. But until we change how the care is delivered, you’ll have to go somewhere, which usually means taking off work, going in the middle of the day, having childcare issues, and so forth.”

Don Lavanty: “I would hope that the technology could get to the point that you could have equipment that goes into a facility. It would be amazing if you could go to a facility like you do for blood testing. I get my flu shots [at a pharmacy]. Can we take it to that level? The unfortunate problem is there’s not a lot of money in mammography, and if I’m a medical manufacturer, I’m not going to put my money there because there’s more in CT, MRI, and nuclear medicine. So, we’ve got a ways to go yet.”

On the podcast, Don and Jessica talk further about making screenings more affordable and accessible—and the need for women’s voices in the healthcare decision-making process.

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Edited by: Matt Maslin