Thursday, January 26, 2006

Unfair comments in the Press About Mammography interpretations

Radiologist's misdiagnosis endangers 17 (Source United Press International)
"At least 17 British women's lives are at risk because a suspended radiologist wrongly told them they were clear of breast cancer, reports said Tuesday. The unnamed doctor -- the only radiologist at Trafford General and North Manchester General in the Manchester, England, area -- was suspended last April based on co-workers' concerns about the accuracy of his diagnoses, Sky News and The Times of London reported. Nearly 2,500 mammograms read by the radiologist since April 2003 were rechecked, 28 of which were misdiagnosed. "

Mammography per se has its own limitations and public should be educated about the possibility of false negative in this test. And so that they develop reasonable expectations of this test or more and more Radiologists will shy away from this test.
Interpretations of mammograms can be difficult because a normal breast can appear differently for each woman. Also, the appearance of an image may be compromised if there is powder or salve on the breasts or if you have undergone breast surgery. Because some breast cancers are hard to visualize, a radiologist may want to compare the image to views from previous examinations. Not all cancers of the breast can be seen on mammography.
From the literature-
N J Med. 2005 Jan-Feb;102(1-2):45-9.
"Concerns about screening mammography include questions of efficacy, high recall rates, false positives, and age at which to institute annual screening. Annual screening mammography can decrease breast cancer mortality by 45% in women over fifty and 23% in women between forty and fifty years of age. Patient recall rates and accuracy of interpretation vary among radiologists. Suggestions for improving accuracy of mammographic interpretation include continuing education with emphasis on quality of interpretation, computer-assisted detection, double reading, increased volume per reader, and performance-related skills testing. Having fewer radiologists reading more mammograms may result in decreased patient access to mammography services. Poor reimbursement for mammography and high prevalence of breast cancer-related litigation are disincentives for radiologists to provide mammography services; these issues must be addressed to ensure patient access to mammography. The public must be educated so that reasonable expectations on the benefits and limitations of mammography will develop."

6 comments:

Anonymous said...

"Annual screening mammography can decrease breast cancer mortality by 45% in women over fifty and 23% in women between forty and fifty years of age."
These numbers are grossly inflated and have never been proven in any randomized control trial. Sure, if you ignore all the studies you don't like, pick only those you like (like two counties - which is not even an RCT) and do some manipulations with the numbers you can get what you claim. The numbers most often cited is 30% for women over 50 and 15-20% for 40-50 women. And even this is very optimistic.
Also, given relative mortality risk reduction is meaningless without considering one's probability of dying from breast cancer in the next 10 years into the consideration. Using relative instead of absolute numbers makes a benefit appear higher than it really is.
http://www.ahrq.gov/clinic/uspstf/uspsbrca.htm
This type of misleading information is what leads to unrealistic expectations in the first place, which in turns leads to lawsuits.
If you want to avoid lawsuits - start telling public the truth:
http://www.imagingeconomics.com/library/200411-02.asp

Sumer's Radiology Site said...

"If you want to avoid lawsuits - start telling public the truth"
This is very well said!!

Jim Hubbard, M.D. said...

I tell my patients that if I send 100 women who have needle-biopsy proven breast cancer to the best radiologists in, say, San Francisco, 15 will be told they have normal mammograms.

Additionally, I tell them that a mammogram cannot diagnose breast cancer. Most are surprised to hear this.

The only diagnostic test for breast cancer is tissue examined by a qualified pathologist.

That said, it's unrealistic to have women come in for their annual biopsy.

There are only two utilities for a mammogram: First, it's used for screening to decide who warrants a biopsy. Second, in a patient with a palpable suspicious mass, a mammogram is a useful survey for the rest of the breast

Dr John Crippen said...

The task for radioligists and indeed histopathologists is impossible; every decision they make during their lives is stored for ever.

A nightmare

http://nhsblogdoc.blogspot.com/2006/01/bit-of-cock-up-in-breast-department.html

Sumer's Radiology Site said...

Read the whole post.. it summarizes the pressure that radiologists and pathologists are under in their jobs very well...

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