Health Care

Lots of women--maybe you're one of them--have gone for a routine screening mammogram only to be told afterward that the radiologist has seen something suspicious on the film. You probably know what follows: These women are told to come back on another day for further imaging, and so they have to go home and wait to find out if they have breast cancer or not. Some women even have to undergo a biopsy during this time.

A waiting game

Finally, the needed number of days drags to an end and the report comes back--and many times it says that the "enhancing areas" seen on the first image, which so concerned the radiologist then, were in fact nothing at all. So everybody exhales, and goes on about their business--but not without an emotional cost. No woman (or family) ever forgets those times spent waiting for that false-positive notice to come back.

The surfeit of false-positive readings draws fire

It's a real drag. And 18 months ago, this issue of false-positive mammogram reports--where a radiologist's initial report of a possible breast malignancy turns out to be mistaken--was generating a lot of criticism from some health professionals. In fact, false positives were 1 of the reasons cited by a panel of independent medical professionals for why they recommended that women between the ages of 40 and 49 not get a screening mammogram every year for breast cancer.

This panel, from the United States Preventive Services Task Force (USPSTF), said that the data from large studies indicated that screening mammography for women before age 50 posed risks that outweighed any benefits.

My concern about the USPSTF's decision

At the time this decree came out, I was opposed to it because I believed the panel was basing its recommendations on a flawed, or at least incomplete, argument. The USPSTF's decision made me uneasy because over the years I'd formed the opinion that most false-positive mammograms reports are produced by general radiologists--those who each month might read a small number of mammograms but who are more likely to spend their work days looking at regular x-rays and MRIs of all sorts of other problems: broken bones, joint pain, sore shoulders, and respiratory infections.

(Currently, in order for the American College of Radiology to certify that a radiologist is proficient in correctly interpreting mammograms, he or she must read at least 960 mammograms every 2 years. I’d gladly see the ACR set that number much higher!)

What a new study has shown

Well, some new data concerning this issue have now been published in the April 2011 issue of Radiology, and they confirm what I've long suspected about mammograms, radiologists, and false-positive reports: Per every cancer detected, compared to regular radiologists, specialist radiologists who read only mammographic images of breasts

have significantly lower rates of false-positive reports

have to call many fewer women back for additional studies

It just makes sense that these specialists are more expert than generalists at interpreting what they see, and so are significantly better at determining which suspicious lesions are not malignant--with the result that they generate far fewer false positives.

The bottom line

So here's the thing: The key is for you to always make sure that the radiologist who's going to be reading your mammogram is someone who specializes in breast imaging.

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