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Leadership Blog

Addressing Challenges in Screening & Mammogram Compliance

Karla Sepulveda, MD, FACR, professor of radiology at Baylor College of Medicine and radiologist at the Dan L Duncan Comprehensive Cancer Center

September 19, 2023 Posted in: Leadership


Mammography is a relatively quick and accurate tool that can help detect disease early and positively affect a woman’s health. Put simply, mammography saves lives. Decades of evidence proves it, and clinicians know it’s true. Convinced of mammograms’ efficacy, lawmakers recently passed legislation requiring most insurance companies to fully cover screening mammograms. Thanks to this step forward, mammography screenings cost women nothing but a little bit of time and discomfort. Despite the known benefits of screening mammograms and the lack of financial burden for patients, many women do not receive the annual screening. 

As clinicians and leaders, our mission is to improve the health of our communities and minimize the harmful effects of disease. Therefore, it’s incumbent upon us to understand our specific communities so we can identify and eradicate obstacles to mammography in an empathetic manner, encouraging trust and increased mammography compliance.

Identifying Care Obstacles

Within my experience, approximately 10 percent of women miss their scheduled screening mammogram. The core reason: fear. They're anxious the screening will detect breast cancer or are afraid the screening will cause them pain.

That’s not the only reason women don’t take full advantage of mammography’s benefits. Many never schedule an appointment in the first place. Common reasons cited for not scheduling a mammogram include:

  • Difficult scheduling process

  • Having to schedule weeks or months in advance

  • Inability to visit the clinic during clinic hours

  • Lack of transportation 


Should a screening mammogram indicate a need for further testing, providers may assume it is natural for women to pursue diagnostic mammograms and other tests. However, even with the threat of breast cancer, a select group of women don’t follow through with additional testing. According to study results presented at a 2022 meeting of the Radiological Society of North America, 21 percent of women would not undergo recommended follow-up tests following an abnormal screening mammogram if the tests required a deductible payment.

Since 2019, certain Texas residents have enjoyed full coverage of diagnostic mammograms. More than a dozen other states have followed suit, but the benefit does not cover all women, and there is much work left to be done.

Overarching Solutions for Increased Mammography Compliance

Once you identify your community’s mammography roadblocks, determine appropriate solutions that eliminate or work around the obstacles.

No matter what obstacles you come across, vigilantly seek out means to improve operational efficiency. One obstacle that affected me in the past was excessive, unnecessary follow-up exams. These cause undue stress to women and fill up the schedule, making it impossible for additional women to undergo screening. To solve this problem, our team worked to ensure our callbacks fell within the FDA’s Mammography Quality Standards Act (MQSA) guidelines. The most instrumental step we took to accomplish this was bringing specialized breast imaging radiologists onto the team.

It’s also smart to invest in care coordinators and nurse navigators. These professionals are exceptional at helping patients understand how to schedule appointments and where and when to attend appointments. If breast cancer is detected, the navigator provides education on diagnosis and treatment options and walks patients through their entire care journey from imaging to surgery to oncology.

Other solutions depend on what women you are attempting to reach.

Women Who Do Not Attend Scheduled Screening Mammograms 

When women don’t attend screening mammograms, call them. This small step indicates that you sincerely care for their good health. It also provides an opportunity to reschedule the missed mammogram to increase the likelihood of detecting breast cancer early. 

Breast clinic administrators should also look for ways to make patients comfortable. Hire skilled, compassionate mammography technologists trained to talk patients through the mammography experience and put them at ease. Create a calm, spa-like atmosphere if possible, providing snacks and comfortable robes. Once women have a positive mammogram experience, they’re more likely to prioritize and return for future screenings.

Women Who Do Not Schedule Screening Mammograms

There are several ways to encourage more women to schedule screening mammograms. Some to consider include:

  • Extend clinic hours. Provide mammography before or after normal work hours or on Saturdays. This can pose operational challenges, but it helps you better serve your patient population.

  • Perform community outreach. Meet your patient population where they are. When engaging your community, speak to them in their native languages. Hire an interpreter if necessary and provide all printed materials in the languages spoken by the women you serve.

  • Simplify scheduling. Today’s health consumer expects choices, and that extends to scheduling appointments. While some prefer to schedule via phone call, many would rather schedule their mammograms online. Make both options available and develop protocols and processes to allow women to get seen sooner if they experience troubling symptoms or are particularly anxious.

  • Take mammography to patients. Mobile mammography vans are a tangible way to improve access to health care. Where this is not possible, partner with local public transportation companies to offer transportation vouchers to women.

  • Use storytelling to promote your mammogram screening program. Humans are emotional beings who respond more positively to narrative than statistics. Remember this when recommending screening mammograms. Without resorting to manipulation, remind women that a screening mammogram can help detect cancer earlier, allowing them to live longer and continue caring for their loved ones. 

Women Who Do Not Attend Appointments for Diagnostic, Follow-up Testing

Patients who need diagnostic breast cancer testing experience anxiety. Scheduling biopsies days or weeks after diagnostic imaging takes place adds to their anxiety. Bring some calm and speed to the diagnostic procedure by providing biopsies the same day as their diagnostic imaging. To provide more peace of mind, consider providing a diagnosis the same day as testing.

Financial counseling can also increase the number of women who undergo follow-up testing after a screening mammogram. Until insurance companies cover diagnostic tests, be upfront and transparent with patients, informing them of their out-of-pocket costs as soon as possible. Because such discussions can embarrass patients, have a financial counselor discuss the cost and options for financial assistance on the phone, rather than in the office.

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