Lisa Evans Labbe, RT, RM, operations manager at the Tucson Breast Center, Ariz, helped build a marketing program around a comfortable mammogram.

High fixed costs and low reimbursements for screening mammograms make it challenging for breast centers to maintain their financial health. Because of low variable costs for mammography, the obvious way for a center to improve its bottom line is to try to increase patient volume. But with many women avoiding mammograms because of the pain, 1,2 it can be difficult for centers to attract new patients. At University Physicians Healthcare, Tucson Breast Center (TBC), in Tucson, Ariz, we addressed these multiple problems with one solution: We adopted a mammography comfort aid—a foam cushion that adheres to the compression plates of the mammography device—and marketed our use of this pad. The pad is cleared by the FDA and has no adverse affect on image quality. The marketing campaign substantially increased both patient volume and revenues. The predicted revenue increase for Year 1 of the campaign, minus the cost for the mammography cushion, is $383,000.

Breast centers face many clinical and financial hurdles. On the clinical side, many patients avoid regular mammograms, even though the procedure is important in detecting breast cancer in an early, more treatable stage. Financially, centers encounter fairly high fixed costs, including site, equipment, and professional and support staff, but receive relatively low reimbursements from government and private payors. The variable costs for mammograms are quite low: about $5 per appointment for film and chemicals. Therefore, increasing volume of screening mammograms is an effective way to meet expenses, because most of the new revenue goes straight to the bottom line. But achieving that increase is often a struggle, in part because of the discomfort issue.

Tucson Breast Center’s administration first learned about the breast cushion in the spring of 2003. According to several studies, this pad made mammograms significantly more comfortable for most women by easing the pressure felt during the compression process and making the device softer and warmer. We felt that by adopting the cushion and marketing its use, we could increase patient volume sufficiently to improve the center’s financial health.

TBC tested the pad with patients during a 2-week period. Women who had the cushion used during their mammogram were asked about their experience. A total of 293 women completed the survey. Of those, 269 reported that the cushion made their mammogram softer and warmer, and 272 said they would like the cushion used on their next mammogram. Technologists also reported excellent results. They said that the pad helped with breast positioning and that women were able to tolerate greater breast compression when the cushion was used.

The decision was made to offer this comfort aid at no charge to all mammography patients. Not long afterward, we began marketing use of the cushion, with full implementation of the marketing campaign in June 2004. The campaign was aimed generally at increasing volume and revenues, but it also included a focus on women who avoided mammograms because of discomfort.

The campaign consisted of the following elements:

  • Giveaway items, distributed at local health fairs and events affiliated with the Susan B. Komen Breast Cancer Foundation. Giveaways included bags filled with educational materials on self-examination, digital mammography, the pad, and CAD, as well as reminder calendars, pens, mints, and a lollipop imprinted with the center name. Past giveaways include fortune cookies with the name and number of the center inside, and drawings for a free mammogram.
  • A poster created by the cushion’s manufacturer that was placed in TBC’s waiting room.
  • Outreach presentations at minority health care centers, senior care centers, referring doctors’ offices, and clinics within the provider’s health care network directed toward medical staff, providers, and clerical staff.
  • An informational letter about the cushion that was sent to 90 top referring physicians.
  • A targeted mailing about the cushion that was sent to 3,600 women in Tucson.
  • Initial and follow-up contacts with all three local TV stations and both daily newspapers. The center received coverage from all three major national television network affiliates in Tucson and both local daily newspapers.

TBC received some professional support for the marketing effort. The cushion’s manufacturer provided mass mailing assistance, and the manufacturer’s public relations firm made the electronic and print media contacts. But the primary work was done by in-house staff at TBC.

The campaign worked. In the first 3 months, our patient volume rose from an average of 63.9 patients per day to 78.5 patients per day—about a 23% increase. Revenues from screening mammograms rose, too—by almost $1,900 per day, which more than offset the cost of the cushion (about $5 per examination). What is more, the increase in volume and revenue occurred during the summer months, a slow period in previous years.

We projected future revenue increases from using and marketing the cushion, based on national averages for mammography reimbursement. The projection conservatively assumed a yearly volume increase of 5%, even though the initial increase over the first summer was 23%. The calculation shows revenue increasing by about $383,000 in Year 1; $510,000 in Year 2; and $643,000 in Year 3.

These figures include both net revenue from an increased volume of screening mammograms and revenue from downstream procedures. An increase in screens can be expected to increase downstream procedures because the screens will lead to increases in cancers detected, confirmatory procedures, and cancer treatment. As with the revenue increase for screening mammograms, the projected increases in downstream revenues were based on conservative assumptions.

Solving the comfort problem, and spreading the word about a more comfortable mammogram in a center’s market, can address several issues. First, it may be the most effective way to increase patient volume—which is the most effective way to improve the center’s bottom line—because it appeals to women who know they should get regular mammograms but avoid them because of pain. Beyond the direct marketing results, a center can expect positive word-of-mouth. The comfort item differentiates the center in the marketplace as a center that cares about its patients, addresses their complaints, and is a state-of-the-art health care facility.

Second, the comfort item helps a center fulfill its mission of detecting as many breast cancers as possible in time to prevent serious consequences for the patient. It is a classic example of an item that is beneficial both clinically and financially.

Lisa Evans Labbe, RT, RM, is operations manager for Tucson Breast Center, Tucson, Ariz.


  1. Dullum JR, Lewis EC, Mayer JA. Rates and correlates of discomfort associated with mammography. Radiology. 2000; 214:547-52.
  2. Carney PA, Harwood BG, Weiss JE, Eliassen MS, Goodrich ME. Factors associated with interval adherence to mammography screening in a population-based sample of New Hampshire women. Cancer. 2002;95:219-27.