"The Facts
Background
The controversy over mammograms has gone on for many years, particularly after a 2011 interview of Richards with Joy Behar on HLN. Referring to a proposal in Congress to pull federal subsidies for Planned Parenthood, Richards said: “What’s going to happen as a result of this is, if this bill ever becomes law, millions of women in this country are going to lose their health care access — not to abortion services, but basic family planning. You know, mammograms, cancer screenings, cervical cancer.”
Conservative activists jumped at this answer, saying that Richards falsely claimed that the organization offers mammograms. Planned Parenthood immediately denied that, saying it offers referrals, not actual mammography.
Her critics have now resurfaced this video, saying her denial at the hearing that Planned Parenthood offers mammograms is a flip-flop from her 2011 claim. We reviewed the transcript and the video, and found that Richards’s answer can be interpreted both ways. She does not directly say the organization offers mammograms.
Yet the dispute over whether Planned Parenthood offers mammograms continued. It came up again during the 2012 presidential campaign when President Obama asserted that women “rely” on the organization for mammograms or that it “provides” mammograms. Obama received Three Pinocchios for repeatedly using misleading words, which suggested an intentional attempt to mislead voters about Planned Parenthood’s services. Planned Parenthood released a statement at the time that it gives referrals and financial help for mammograms.
Current debate
Mammograms have come to symbolize whether Planned Parenthood is a health-care organization that does cancer screenings, as supporters say — or a front for an organization that is mainly an abortion provider masquerading as a reproductive health organization, as opponents say. Democrats point to mammograms, as an example of a service that women can have access to via Planned Parenthood. Republicans seeking to defund Planned Parenthood show that since it doesn’t offer mammography X-rays, federal funding should be diverted to federally qualified health-care clinics that actually do.
Planned Parenthood’s annual report shows it gave 487,029 breast exam services for women in 2013. This is a clinical breast exam, checking for changes or lumps in women’s breasts. If the doctor finds something abnormal or worth checking out, the patient is referred for a mammogram, which requires X-rays given at a licensed radiology facility. Planned Parenthood does administer Pap tests and HPV tests, both of which screen for cervical cancer.
Richards said during the hearing that Planned Parenthood clinics do not have mammogram machines. The Federal Drug Administration’s list, updated weekly, of certified mammography facilities does not list any Planned Parenthood clinics. Some Planned Parenthood affiliates host free mammography mobile vans for low-income and uninsured women.
Despite the ongoing emphasis on Planned Parenthood’s mammogram referrals, this service does not reflect the core clients of the organization — certainly not clients in the reproductive age or have the highest rate of first-time abortions. Mammograms are recommended once a year for women 40 to 49, and every other year for women 50 to 74 years. Referrals are less commonly made for women under 40.
In 2013, about 7 percent of Planned Parenthood clients were women over 40 years old. This figure has remained steady over the past few years, according to the organization. So, when people talk about Planned Parenthood clients who need mammography referrals the most, they are referring to a small percentage of total patients.
Further, less than 3 percent of the breast exams offered at Planned Parenthood resulted in mammography referrals. Out of 487,029 breast exams in 2013, about 14,000 resulted in a client referral for mammography and other specialized providers, according to Planned Parenthood.
Proponents argue that defunding Planned Parenthood would mean women would lose “access” — the key word — to mammograms. The argument is that pulling federal funding — the majority of which is through Medicaid reimbursements for low-income women — means fewer women would use Planned Parenthood for family planning or reproductive care. As a result, fewer women would get free or low-cost breast exams, which could lead to mammography referrals.
On the other side, opponents argue federally qualified health centers can absorb what Planned Parenthood does – a point that is still in question (we explored this in another fact check) and that money should be directed to centers that actually do mammograms. A recent study in the Journal of Women’s Health found that about two-third of these centers in 2012 offered mammography. However, the breast cancer screening rates at these centers were lower than the national average, and offering screening was most effective in urban or white counties.
Maloney, other Democratic lawmakers and Richards say that women have “access” to mammograms through Planned Parenthood. As we noted in 2012, we recommend using terminology that clearly show Planned Parenthood does referrals, rather than actual mammograms. “Access” is still a slippery word as it can be misconstrued, but it is more accurate than “provides.”
Maloney said in a statement: “Anyone who has ever had a routine well woman visit understands that after a breast exam, a doctor may refer a woman to a radiologist for a mammogram. In her testimony, Cecile Richards made it clear that is exactly what Planned Parenthood does, and that’s precisely what I was referring to. Attempts to split hairs on this issue ignores the more important point: many women would not have access to mammograms without Planned Parenthood. Many Planned Parenthood clinics hosts visits by mobile-mammogram vans, and help women find grants to pay for mammograms so that they can afford these services.”