Outrage erupted yesterday over a 33 percent cut in insurance company payments for mammograms -- sparking fears of a rise in undetected breast cancer.

Bermuda Health Care Services say they have been told payments for a mammogram will go down from $113.65 to $75.

Yesterday BHCS's Medical Director Dr. Ewart Brown, also Shadow Human Affairs Minister, said the move was "irresponsible, reckless and insensitive''.

He pointed out annual mammograms were performed on more than 500 women at BHCS.

And he urged women to voice concern to the Health Insurance Association of Bermuda (HIAB).

But last night HIAB president Nicholas P. Warren hit back: "I am extremely disappointed in Dr. Brown as a professional that he has chosen to present such a biased, inflammatory and misleading version of the issue of mammogram reimbursement by insurance companies.'' Mr. Warren said the $113 reimbursement had only been for the initial mammogram.

Payments for subsequent or follow-up mammograms were calculated to be $65.20.

"An allowance was, therefore, made for the additional administration and time required on the very first occasion.

"A review of claims received by members of the HIAB indicated that claims submitted as initial mammograms were, in fact, annual or follow-up mammograms.'' Mr. Warren said the HIAB executive decided after extensive investigation and discussion -- including talks with the Bermuda Medical Society -- that a combined "or composite'' reimbursement rate of $75 should apply to any mammogram, whether initial or subsequent.

"The rate was, therefore, decreased for initial and increased for any subsequent mammogram.'' Brown calls for Govt. probe of insurance firms over payments cut Dr. Brown yesterday called on Government to investigate the actions of insurance companies. He described the HIAB's move as "unbelievable and unfortunate''.

"The women of Bermuda should be outraged by this cold and callous step taken by the insurance association.

"It is particularly incredible since women are well represented on the HIAB.

"I would have thought that women of the higher echelons in the insurance business would have refused to join in this assault on their fellow women.'' Dr. Brown said he received a letter last month from Mr. Warren which stated the payment for a mammogram would be reduced to $75 from January 1997.

U p to now, insurance had covered the total cost of a mammogram at BHCS, he added.

"It looks like we have been targeted.'' He continued: "I don't have a problem with the insurance companies trying to be profitable, but to do so at the risk of increasing undetected breast cancer is morally reprehensible.'' Dr. Brown said the HIAB had routinely paid $114 for a mammogram.

He added a misunderstanding arose as to whether an annual mammogram should be covered in the same way as an initial one.

The Bermuda Medical Society, said Dr. Brown, had taken the position that all mammograms be treated the same as far as payment was concerned.

"Rather than pay for all studies at the customary rate, the HIAB has chosen to slash the payment, thereby causing women to absorb the difference of $38.

"It doesn't take an expert to realise that when the patient has to pay this cost, the end result is that fewer patients will have the test and therefore more of them will miss the opportunity for early breast cancer detection.

"This decision by the HIAB is irresponsible, reckless and insensitive. It has major implications for the entire health care industry in Bermuda.

"What will they do next? Will they reduce their payment for prostate cancer screening? I call upon the HIAB to reconsider their decision.'' Dr. Brown said Finance Minister Grant Gibbons should investigate the way insurance companies could "willy-nilly'' reduce benefits to insureds while steadily increasing the cost of premiums.

"Also, he has an obligation to the people of Bermuda to stop the economic war being waged against certain businesses.'' Dr. Brown continued by urging Health Minister Clarence Terceira to decide whether the "profits before people'' approach was in the best social interest of Bermudians.

He also called on women to contact Mr. Warren on 295-2021 and express their concern.

"Let him know that you are outraged by this blatant act of discrimination against women. Insist that your annual mammogram be a covered benefit at the previous rate.'' Last night Dr. Terceira said he would investigate Dr. Brown's complaint and talk to Chief Medical Officer Dr. John Cann.

Dr. Gibbons said the way insurers worked in the health care system with hospitals and doctors was already being examined.

This was an issue which emerged from Bermuda's recent health care review, he added.

Mr. Warren said the HIAB would continue to recommend reimbursement for services or procedures performed by medical practioners at levels which were considered to be reasonable and customary.

"The responsibility for what is charged, in this instance, rests entirely with the person providing the service.'' Between 1983 and 1993, a total of 328 women were diagnosed in Bermuda with breast cancer. Of those, 99 have died.

Breast cancer is still the most common form of cancer, and one out of every nine women will develop it. The diagnosis, however, does not automatically mean removal of the breast.

A woman is said to have a higher than average risk if she is over 40, has a family history of breast cancer such as a mother or sister or if she eats a high fat diet.

Doctors say the best protection is early detection.

The American Cancer Society recommends one baseline mammogram by the age of 40, a mammogram every one-two years from age 40 to 49, and yearly mammograms from 50 onward.

A mammogram is a safe, low dose X-ray technique that creates images of the inside of the breast. Mammography can detect lumps before they can be felt.

Two years ago researchers at the University of California in San Francisco fuelled a long-standing medical controversy when they announced their conclusion that mammography has little benefit for women under 50.

The researchers based their finding on a review of 13 breast cancer studies between 1966 and 1993 and construed that mammography reduces breast cancer mortality by 26 percent in women aged 50 to 74 but does not significantly reduce mortality rates in those aged 40 to 49.

But the American Medical Association disagreed with the conclusion and said it still recommends mammographies every one to two years for women between the ages of 40 and 50.

Bermudian mammography experts have been as divided on the issue as their American counterparts.