Practical Steps to Increase the Benefit of Mammography

December 31, 2006

Although mammographyis still generallythought to be advantageous,a number of problemswith this screeningtool have recently beenbrought to light. Some ofthe latest studies suggestthat mammography maynot be as effective as washoped at decreasing mortalityfrom breast cancer.Moreover, the quality ofmammography itself hasbeen questioned-both theprocessing of films andtheir interpretation by radiologists.1 Errors can occuras a result of inadequateexposure or insufficientpenetration of the film. Radiologistswho have lesstraining in mammographyor who read a lower volumeof mammograms maymake more errors in interpretation.There are clearvariations between mammographycenters in ratesof false-positive and falsenegativeresults. While theanxiety and costs associatedwith false-positives areimportant, higher rates offalse-negatives are of mostconcern.

Although mammographyis still generallythought to be advantageous,a number of problemswith this screeningtool have recently beenbrought to light. Some ofthe latest studies suggestthat mammography maynot be as effective as washoped at decreasing mortalityfrom breast cancer.Moreover, the quality ofmammography itself hasbeen questioned--both theprocessing of films andtheir interpretation by radiologists.1 Errors can occuras a result of inadequateexposure or insufficientpenetration of the film. Radiologistswho have lesstraining in mammographyor who read a lower volumeof mammograms maymake more errors in interpretation.There are clearvariations between mammographycenters in ratesof false-positive and falsenegativeresults. While theanxiety and costs associatedwith false-positives areimportant, higher rates offalse-negatives are of mostconcern.The underlying problem.In this country, thereis currently no uniformmethod of tracking healthcare results. Many centershave no way of followingwomen who obtain mammogramsto see if breastcancer develops within ashort time of a negativescreening result. Without awell-designed and fundedinformatics approach, thetask of overseeing the accuracyand quality of mammographycannot be handledby already overburdenedstate governments.Thus, in our current system,accurate tracking ofmammography results isnot feasible.Steps to ensure higher-quality mammograms.Try to refer patients to centersthat read higher volumesof mammograms andthat have good internalmammography quality reports--although for thosewhose practice is in a ruralarea or among underservedpopulations, this may notbe a realistic option. If a patienthas specific concerns,it may be reasonable tohave her mammogramread by a referral center.Future advances incomputer analysis and thedevelopment of other methodsof screening for cancermay hold promise, but untilthese become reality, wemust advise patients aboutan imperfect test in an imperfectworld. This is notuncommon in medicine.

References:

REFERENCE:


1.

Moss J. Spotting breast cancer:doctors are weak link.

New YorkTimes

. June 27, 2002.