The effectiveness of mammography as a cancer detection technique is  directly tied to the quality of mammography procedures. National Capacity for Mammography Services Is Generally Adequate

The nation’s overall capacity to meet the growing demand for  mammography services is generally adequate. Between 1998 and 2000, screening rates for  women in this age group increased in all but one state (i.e., Oklahoma) and  the District of Columbia, and 39 states had an increase of more than   10 percent in the total number of women age 40 and above who had  received a mammogram within the past year. Counties with Largest Losses Are Mostly Rural; Most Reported No Significant Problems

Because data are not available to measure the effect of capacity loss on  the mammography utilization rates at the county level, we randomly  selected 37 of the 121 counties that lost more than 25 percent of their  machines for in-depth analysis at the local level. While no problems were reported in nine counties,  officials in the other nine counties reported a variety of problems. In Chicago, Houston, and Los Angeles, long  waiting time problems were concentrated in public health facilities that  served low income populations. In almost all cases  where some problems were reported, officials said that women who  needed a diagnostic mammogram generally were able to get appointments  within 1 to 3 weeks. All of  these 18 counties are in metropolitan areas. For each selected  location, both rural and metropolitan, we interviewed officials familiar  with the availability of mammography services in these areas to obtain  their views on whether women in their areas were experiencing problems  with long waiting times for appointments and/or long travel distance to  obtain services.
What GAO Found

Breast cancer is the second leading cause of cancer deaths among American women. In 2001, 192,200 new cases of breast cancer were diagnosed and 40,200 women died from the disease. The probability of survival increases significantly, however, when breast cancer is discovered in its early stages. Currently, the most effective technique for early detection of breast cancer is screening mammography, an X-ray procedure that can detect small tumors and breast abnormalities up to two years before they can be detected by touch. Nationwide data indicate that mammography services are generally adequate to meet the growing demand. Between 1998 and 2000, both the population of women 40 and older and the extent to which they were screened increased by 15 percent. Although mammography services are generally available, women in some locations have problems obtaining timely mammography services in some metropolitan areas. However, the greatest losses in capacity have come in rural counties. In all, 121 counties, most of them rural, have experienced a drop of more than 25 percent in the number of mammography machines in the last three years. Officials from 37 of these counties reported that the decrease had not had a measurable adverse effect on the availability of mammography services. By contrast, in 18 metropolitan counties that lost a smaller percentage of their total capacity, officials in half of the counties reported service disruptions. Officials from six other urban areas, including Houston and Los Angeles, reported that public health facilities serving low income women had long waiting times. However, most women whose clinical exam or initial mammogram indicated a need for a follow-up mammogram were able to get appointments within one to three weeks.