Poor Diagnosis

It is called the moment of metastasis.

It is the time when a growth in a woman’s breast spreads to the rest of the body, firing off cancer cells like bombs.

It is the moment when surgery alone no longer can solve the problem. Instead, treatment will require major surgery and multiple injections of chemicals. Even then, the cancer may not be defeated.

The best way to find cancer while it is still easily treatable is through regular mammograms. Because of that, mammograms should be as common as dental checkups.

“We should be seeing virtually every woman in the city being examined routinely,” says Gary Baker, a board member for the Kansas City affiliate of the Susan G. Komen Foundation.

They aren’t.

Komen as an organization is dedicated to seeing more poor women in particular screened for breast cancer. Despite the success of the annual Race for the Cure fundraiser, despite occasional special events offering free or reduced-cost mammograms, Kansas City can boast no significant progress in seeing more women receive mammograms.

For each gain, such as the addition of a mobile unit through St. Luke’s Hospital or a streamlined system at Truman Medical Center, there has been a defeat, such as the abrupt cancellation in December of KU Medical Center’s mobile mammography program.

Baker says the availability of mammograms for poor women actually has declined in recent years. It is harder, he says, to find hospitals willing to take referrals for mammograms. “Five years ago we didn’t seem to have this problem,” Baker says. “Something has changed in the last three or four years.”

Baker believes the blame can be spread around: low mammogram reimbursement rates through government and private health benefit packages; radiologists who fear the liability of a misdiagnosis; hospitals that lose money on the mammograms and stand to lose much more by being saddled with the cancer treatment costs of uninsured women.

Janet Lancaster, a clinic manager with Planned Parenthood of Kansas and Mid Missouri, says the problem is more acute on the Kansas side of the metro area. Frustrated by an attempt to get a woman with a breast lump seen at KU Med, Lancaster tapped the last resort for the uninsured.

“I had to finally send her to the ER,” Lancaster says.

Baker understands that the hospitals have legitimate issues.

The financial officers at Truman Medical Center estimate the hospital’s cost to perform mammograms at $76 each. The number includes radiologists’ time, X-ray materials and follow-up costs. Yet the hospital can expect reimbursements of only about $47 from patients who qualify for Medicare, $55 through Medicaid and $61 through private insurers.

Meanwhile, radiologists are fearful of the lawsuits that would accompany a misdiagnosis.

“The breast is not only a high medical risk but a high legal risk as well,” says Dr. Gordon Clark, director of the diagnostic breast center at Truman.

Truman is held up as an example of the right way to set up a breast cancer treatment center. Clark says the hospital’s new system can lead a woman through a mammogram, sonogram and biopsy in hours rather than days.

KU Med, on the other hand, is seen as a growing problem. The institution abruptly shut down its mobile unit in December. The closing came with fifty women signed up for a planned screening event, says Connie Lindsey of the Black Health Care Coalition at 6536 Troost.

The hospital said the unit “was discontinued due to staffing and financial issues.” After separating from the University of Kansas in 1998, the medical center lost its state subsidy. Although the hospital provided $20 million in free care last year, income-generating services are a higher priority. Mammograms for poor women don’t make money.

“The sort of dirty little secret, especially for poor women, is when [the hospitals] actually detect something _ then they are sort of on the hook to do something about it,” Baker says. “That is a very expensive proposition when the woman does not have resources.”