Radiologists Blamed In Mommogram Debate

Radiologists Blamed In Mommogram Debate

There are 8 comments on the The Hartford Courant story from Dec 21, 2009, titled Radiologists Blamed In Mommogram Debate. In it, The Hartford Courant reports that:

An Avon-based company that advises dozens of health insurers nationwide says the real problem with mammograms is radiologists who aren't reading them correctly.

Join the discussion below, or Read more at The Hartford Courant.

Anoym1

United States

#1 Dec 22, 2009
Here's another twist to this story. Does the medical profession and the general public understand the insurance ramifications of being called back for a diagnostic mammogram for those who are unemployed or self-employed, and might wish to obtain an individual health insurance policy in the near future?
If you have a diagnostic mammogram whereby a radiologist says "let's just put you on a watch to make nothing else comes of this... I want to see you in another 6 months (instead of the typical 1 year) for a comparative mammogram ď.... YOU WILL NOT BE ABLE TO OBTAIN A NEW INDIVIDUAL HEALTH INSURANCE POLICY until such time that the doctor's report totally clears you (likely even a year or more later, depending on the insurance company)!!!
I know.... it happened to me in the state of South Carolina! My only option for a new policy was to go on the state plan of last resort (VERY, VERY expensive and poor coverage). The insurance companies saw me as HAVING cancer, even though all I had was a diagnostic report under my belt that said I had a few microcalcifications, and was to come back in 6 months for a comparative mammogram.(Note: Calcifications are not breast cancer. 80 percent of microcalcifications are benign. However, sometimes calcifications are an indication of a precancerous condition. They appear as white dots on mammograms. Source: http://breastcancer.about.com/od/mammograms/p... ).
Gail Perry

Plant City, FL

#2 Dec 22, 2009
It's UTTER RUBBISH that radiologists are to blame for "false positives."

First, mammograms don't GIVE either positives or negatives. They identify (sometimes) suspicious areas that need to be evaluated further. That's not a "false positive." It's ... a need for further evaluation.

Second, suspicious mammograms do not lead to more radiation. The other tests used -- ultrasounds and MRI's -- do not use any radiation. The person who made up that lie for this article should be called to account, and that sort of bias makes the whole article suspect to me.

Third, it isn't the end of the world to experience a little anxiety. Sooner or later -- unless a refrigerator falls on us or something else unexpected -- we are ALL going to get bad news from the doctor, because sooner or later we are all going to die. The question is whether a specific person will die of breast cancer, or will that person be able to fight it off successfully and die of something else later on?

It's just plain insulting when writers whine about "unnecessary anxiety." It smacks of the attitude from the 19th century where women's psyches were truly believed to be more fragile than men's.

No one WANTS to have a questionable mammography, but it's not the radiologist's fault that the test isn't perfect, and we women can take the strain. Really.
Gail Perry

Plant City, FL

#3 Dec 22, 2009
Anom, first of all, a "diagnostic" mammogram is nothing more than a digital mammogram, which is what people should be getting to begin with.

Sure, if you want to buy insurance in the near future, a questionable mammogram is a problem. But so is even just one blood pressure reading that is marginally high. I know someone who was turned down because she was on a medication for allergies.

Your concern about obtaining insurance is exactly why Congress is working so hard to write a medical reform bill. Unfortunately, having microcalcifications really is enough to block a person from health insurance. But so are hundreds, probably thousands, of other things.
Rad1

Saint Charles, MO

#4 Dec 22, 2009
Gail, a "diagnostic" mammogram is certainly not a digital mammogram.

There are two types of mammograms- Screening, which is just that- a screening exam consisting of a few routine pictures of the breast.

A diagnostic mammogram is a more detailed exam with specialized pictures of the breast done when something abnormal shows up on a screening mammogram. They are usually checked immediately by the Radiologist to ensure that no further mammogram images are needed.

Digital mammograms are a different animal. Conventional mammograms (and x-rays) are done with film based cassettes and processed thru a film processor with chemicals.

Digital mammograms (and x-rays) are done without film and are digitally produced thru plates read by a cassette reader or with a digital plate built into the machine itself. These images can then be stored & viewed electronically and have the benefit of never being lost, unlike film based x-rays which can easily be lost or misplaced.

And Anoym1, your issues is with your insurance company, not the radiologist. Would you prefer they just ignored a potentially suspicious finding? Sure, microcalcifications can be benign, but they can also not be.
Gail Perry

Plant City, FL

#5 Dec 22, 2009
Rad1, I have HAD breast cancer, and my oncologist says that a digital mammogram IS a diagnostic mammogram -- as diagnostic as they can get. If you get a digital mammogram for your screening, there are no more mammograms appropriate in the diagnostic process.

You don't know the whole difference between digital mammograms and the older film ones: THE DETAIL in the image.

What I'm saying is that women should not even get the older kind of mammogram. Go straight for the digital from the very beginning.

See, I've been there. My first mammogram was a digital mammogram. That's as good as mammograms get, and we went from there to ultrasound, and then ultrasound-guided needle biopsy.

The best way to reduce the number of screening mammograms that show areas of concern that turn out non-malignant is to start -- START -- with a digital mammogram. Even then there will still be suspicious areas that turn out to be nothing, and there will still be digital mammograms that miss tumors that are there ... but the numbers improve significantly.

Women, get a digital mammogram from the beginning. ESPECIALLY if you have reason for concern (found a lump, or oozing from nipple, or "orange peel" skin, for instance, insist on a digital mammogram. The old film is dated technology and just not as good.

And by the way, Rad, I have a "diagnostic mammogram" every year on my remaining breast. It's called "digital." There just is no point in promoting old technology. Do not pass GO, do not collect $200 -- go straight to a digital mammogram. Time is precious when you might have breast cancer.

Women ask your doctors which is better.

Theresa

Jackson, MI

#6 Dec 23, 2009
The mammography industry chooses to blame the radiologist but the real problem is mammography itself. An X-Ray procedure, any X-Ray procedure works by contrasting dense from non-dense tissue. While that principle works well when studying bone structure, last time I checked, there were no bones in breast tissue. Micro-calcifications show up well but they occur as a response to tissue stress, a possible secondary to breast cancer but also many other conditions (mastitis, prior biopsies, physical trauma). Fibrocystic changes, highly glandular or dense breast tissue do not look much different from breast cancer by mammography. Let's face it, mammography may be a useful diagnostic tool for breast cancer detection but it has been very much 'over hyped' by the mammography industry and the American College of Radiology as a 'stand-alone' test. Only recently are the deficiencies of mammography revealed to the medical profession and the public. They are left confused and feeling betrayed. Women and their physicians need to look into viable alternatives, such as breast thermology and blood markers for primary screening. The risk for breast cancer hasnít gone down and early detection is more important than ever as it gives access to the new targeted therapies.
Gail Perry

Saint Petersburg, FL

#7 Dec 23, 2009
I don't think mammography has been "over-hyped." The doctors tell you that it can miss cancer. If they find something, the first thing they tell you is that mammograms cannot diagnose cancer.

It's a screening tool, like breast self-exams. Like breast exams -- whether done by you or your doctor -- is not perfect.

For high risk women there are breast MRI's. But it's not true that the "deficiencies" have "just been revealed. We use mammograms because it's the best we have, not the best we want.
Rad1

Saint Charles, MO

#8 Jan 15, 2010
Gail, sadly you don't understand what you're talking about.

There are two methods of producing x-ray images. You can use a film/screen method which uses florescent screens inside a cassette with a piece of film or you can used a digital cassette which, wait for it, digital and read electronically.

Until some years ago, mammography was typically performed with screen-film cassettes. Now, mammography is undergoing transition to digital detectors, known as Full Field Digital Mammography (FFDM). This progress is some years later than in general radiology. This is due to several factors:

1. the higher resolution demands in mammography,
2. significantly increased expense of the equipment,
3. the fact that digital mammography has never been shown to be superior to film-screen mammography for the diagnosis of breast cancer.

"Work-up" process

In the past several years, the "work-up" process has become quite formalized. It generally consists of screening mammography, diagnostic mammography, and biopsy when necessary, often performed via stereotactic core biopsy or ultrasound-guided core biopsy. After a screening mammogram, some women may have areas of concern which can't be resolved with only the information available from the screening mammogram. They would then be called back for a "diagnostic mammogram". This phrase essentially means a problem-solving mammogram. During this session, the radiologist will be monitoring each of the additional films as they are taken by a technologist. Depending on the nature of the finding, ultrasound may often used at this point, as well.

So you have two choices for performing mammograms- film/screens or digital.

With either option- you can do screening mammograms (for routine evaluations) or diagnostic (more specialized work up for suspicious cases).

Diagnostic and digital are two different things.

I patiently wait for my 200 dollars.

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