Under this program, CDC makes grants  to states to provide mammography services to medically underserved  women, especially those with low incomes and without health insurance  coverage. Facility Closures Outpaced Openings, with Financial Considerations Most Often Cited as Reason for Closure

From October 2001 to October 2004, certified mammography facility  closures outpaced openings, and financial considerations were most often  cited as the reason for facility closures. According to FDA data, the  number of certified mammography facilities nationwide decreased by   6 percent, from 9,306 to 8,768, from October 1, 2001, to October 1, 2004. During this period, 1,290 certified mammography facilities closed, while  752 facilities received 6-month provisional certificates to begin providing  services, resulting in a net decrease of 538 facilities, including a net  decrease of 87 mobile mammography facilities, which may serve multiple  locations. For certified mammography facilities that had been  accredited by ACR and that closed from October 1, 2001, to   October 1, 2004, facility officials most often reported financial  considerations as the reason for closure. Although Key Capacity Elements Have Decreased and Use of Mammography Services Has Increased, Current Nationwide Capacity Is Adequate

Although key elements that make up mammography capacity have  decreased and the use of mammography services has increased—largely  because of the increase in the population of women age 40 and older—we  found that current nationwide capacity is adequate. Our estimates of current capacity found that the number of mammograms  performed by U.S. machines was substantially lower than the number that  could be performed. Most of the experts we interviewed told us that current overall capacity is  likely adequate, but all of the experts expressed concern that the numbers  of radiologic technologists and radiologists entering the mammography  field might not be adequate to serve the increasing population of women  age 40 and older. Loss or Absence of Mammography Machines May Have Resulted in Access Problems in Certain Locations

The loss or absence of mammography machines in certain locations may  have resulted in access problems consisting of lengthy travel distances or  considerable wait times to obtain mammography services, including  problems for women who are medically underserved. During the 3-year period, 117 counties lost  more than 25 percent of their machines. While the majority of officials we  interviewed told us that the loss of machines in counties in their states had  not resulted in access problems, some officials told us that the loss or  absence of machines in certain counties had resulted in lengthy travel  distances to obtain services or had resulted in significant wait times for  services. The majority of officials we interviewed about the  effects of the loss or absence of machines told us that machine losses had  not resulted in access problems because women were able to obtain  mammography services at other facilities. Access problems for these women are of particular  concern because they have lower-than-average mammography screening  rates. We incorporated FDA’s comments as  appropriate. To examine changes in the nation’s capacity for and use of mammography  services in recent years and the adequacy of current capacity, we analyzed  data from FDA’s Mammography Program Reporting and Information  System database on the total numbers of certified facilities, machines,  radiologic technologists who perform mammography, and physicians who  interpret mammograms as of October 1, 2001, and October 1, 2004. To determine the adequacy of current capacity,  we obtained estimates from mammography experts of the amount of time  it takes to perform a screening mammogram, and we used those estimates  and FDA data on the number of machines available in 2003 to calculate the  number of screening mammograms that potentially could have been  performed in 2003. For our third step, to provide additional information on the effects of  facility closures on access for medically underserved women, we  interviewed state officials who direct CDC’s National Breast and Cervical  Cancer Early Detection Program and officials of community health  centers.
Why GAO Did This Study

Mammography, an X-ray procedure that can detect small breast tumors, is an important tool for detecting breast cancer at an early stage and, when coupled with appropriate treatment, can reduce breast cancer deaths. In 2002, GAO reported in Mammography: Capacity Generally Exists to Deliver Services (GAO-02-532) that the capacity to provide mammography services was generally adequate, but that the number of mammography facilities had decreased by 5 percent from 1998 to 2001 and that about one-fourth of counties had no machines. GAO was asked to update its information on facility closures and mammography service capacity. The Food and Drug Administration (FDA) regulates mammography quality and maintains a database on mammography facilities and other capacity elements. GAO reviewed FDA data on facility closures and examined reasons for closures in recent years. GAO analyzed changes in the nation's capacity for and use of mammography services using FDA capacity data and National Center for Health Statistics data on service use. GAO also interviewed state and local officials about the effects of the loss or absence of mammography machines on access, including access for medically underserved women, such as those who are poor or uninsured.

What GAO Found

Closures of certified mammography facilities outpaced openings during a recent 3-year period, and financial considerations were most often cited as the reason for facility closures. FDA data show that from October 1, 2001, to October 1, 2004, the number of mammography facilities nationwide decreased from 9,306 to 8,768. During this period, 1,290 facilities closed and 752 began providing services, resulting in a net loss of 538 facilities, or 6 percent. Mammography facility officials most often cited financial considerations as the reason their facility closed. Experts said that another factor that could affect closures is difficulty recruiting and retaining radiologic technologists who perform mammography and physicians who interpret mammograms. Although key elements that make up mammography capacity have decreased and the use of screening mammography has grown, current nationwide capacity is adequate. The numbers of mammography facilities, machines, radiologic technologists, and interpreting physicians decreased from 2001 to 2004. From 2000 to 2003, the estimated number of women who received a screening mammogram increased, mostly because of population growth. Based on GAO's calculation that the estimated number of mammograms performed in the United States in 2003 was substantially lower than the number that could have been performed, GAO found that current capacity is adequate. Most of the experts GAO interviewed believe the nation's current overall capacity is likely adequate, but all of the experts expressed concern that the flow of personnel into the field may be insufficient to serve the growing number of women needing screening. This potential development could result in access problems in the future. The loss or absence of machines in certain locations may have resulted in access problems, including problems for women who are medically underserved, such as those who have a low income or lack health insurance. About one-fourth of counties had no mammography machines in 2004. The majority of officials GAO interviewed about access in their states, including access in 18 of the 117 counties that had lost over 25 percent of their machines from 2001 to 2004, said that machine losses had not resulted in access problems because women were able to obtain services at other facilities. However, some officials told GAO that the loss or absence of machines in certain counties resulted in access problems consisting of lengthy wait times or travel distances to obtain services. Lengthy travel distances may especially pose an access barrier for medically underserved women. Access problems for these women are of concern because uninsured and poor women have lower-than-average screening mammography rates. In commenting on a draft of this report, FDA provided additional details and clarification regarding aspects of its regulation of mammography, which GAO incorporated as appropriate.