Doctors Unfit To Read Mammography?

The New York Times reports in a two-part series published this week that the United States government has fallen far short of its pledge to provide safe and high-quality mammograms.

The Early Show talks with Times reporter Michael Moss about many doctors reading mammography images today that are not skilled or experienced enough to effectively manage this difficult task.

“New research is revealing that radiologists miss far more tumors than previously assumed,” says Moss. “Many of them simply lack the ability to discern the elusive signs of breast cancer in the shadows and swirls of a mammogram widely regarded as the hardest task in all of radiology.”

Mammography is a type of imaging that uses low dose of x-ray and high-contrast, high-resolution film for examining breast. The equipment should detect cancer cells in its early stage for treatment.

The New York Time’s series reports that mammography is valuable only if done well and while machines are inspected for quality, the government does little to monitor the interpretative skills of the doctors.

Currently, the government has no method of tracking those doctors who miss cancers. Moss claims that efforts to guarantee high-quality mammograms for all women have been compromised by the campaign to screen as many women as possible.

Some 30 million women undergo mammograms in the United States every year. The “New York Times” reports that many of the 20 thousand American doctors who examine mammograms still lack the specialized skills necessary to do so effectively and neither they, nor their patients, have the tools to find out which doctors are competent and which are not.

“Little specialized training is required,” says Moss. “While studies indicate that
doctors need to read at least 2,500 films each year to stay sharp, the government mandates a mere 480, a number many experts say is so low as to be virtually meaningless.”

Moss reporting discloses the history of mammography screening and the lax manner in which mammography clinics are overseen by the government. The report also discovers lingering problem of deficient X-ray images, minimal specialty training for the doctors who read the films and the rash of malpractice complaints stemming from missed breast cancer.

To help find reliable mammography, Moss recommends women follow these tips:

• Find a clinic where doctors read large numbers of mammograms, far beyond the 480 a year required by the F.D.A.
• Insist on having your films read by the ``lead interpretive physician,'' who oversees a clinic's quality controls.
• Look for doctors who did fellowships in mammography, or those who spend at least half their time reading mammograms. At the very least, seek out an enthusiast who goes to meetings and perhaps writes about mammography.
• Look for clinics where two doctors independently interpret every film.
• Ask about ‘medical audits,’ which show if a doctor sends too many women for biopsies.
• Use open-records laws to obtain a clinic's inspection reports, which list violations and chart the image-quality test known as the ‘phantom.’ Look for a combined score of 12 or more. Beware of citations for equipment failures or missing ‘QC,’ or quality control records.
• Don't press for an instant interpretation of your films. A day's delay through ``batch'' reading can maximize a doctor's power of concentration.
• Don't put too much faith in a doctor being board certified in radiology. Many doctors passed before the late 1980's, when mammography was added to the exam. In any case, the number of practice mammograms it now includes does not reflect the rigors of real-world screening.
• Don't judge doctors by the lawsuits they have lost for misreading mammograms. Even the best doctors will miss some cancers.
• Don't put too much faith in promising but still unproven technologies like digital X-ray machinery and computer programs.
• Don't have your mammogram done on Mother's Day, when many clinics offer free or discounted exams. These programs can swamp the doctors and rush the reading.
  

“Comparison shopping for mammograms is not easy," says Moss. “The government does not gather much of the information that experts say women need.” He warns it is up to the women to improve their chances of getting their mammography correctly read.