There’s a new study out on mammography with important implications for breast cancer screening. The main result is that when radiologists review more mammograms per year, the rate of false positives declines.
The stated purpose of the research*, published in the journal Radiology, was to see how radiologists’ interpretive volume — essentially the number of mammograms read per year — affects their performance in breast cancer screening. The investigators collected data from six registries participating in the NCI’s Breast Cancer Surveillance Consortium, involving 120 radiologists who interpreted 783,965 screening mammograms from 2002 to 2006. So it was a big study, at least in terms of the number of images and outcomes assessed.
First — and before reaching any conclusions — the variance among seasoned radiologists’ everyday experience reading mammograms is striking. From the paper:
…We studied 120 radiologists with a median age of 54 years (range, 37–74 years); most worked full time (75%), had 20 or more years of experience (53%), and had no fellowship training in breast imaging (92%). Time spent in breast imaging varied, with 26% of radiologists working less than 20% and 33% working 80%–100% of their time in breast imaging. Most (61%) interpreted 1000–2999 mammograms annually, with 9% interpreting 5000 or more mammograms.
So they’re looking at a diverse bunch of radiologists reading mammograms, as young as 37 and as old as 74, most with no extra training in the subspecialty. The fraction of work effort spent on breast imaging –presumably mammography, sonos and MRIs — ranged from a quarter of the group (26 percent) who spend less than a fifth of their time on it and a third (33 percent) who spend almost all of their time on breast imaging studies. Read more »
I’ve written a few times about Veneta Masson, a nurse practitioner who wrote in Health Affairs and the Washington Post about her decision to forego further mammograms despite the fact that she was in a higher-risk category.
Veneta is also a poet. She sent me a video animation of her poem “Reference Range,” which I’m pleased to share with you. I think the poem and the video are beautiful, touching on important issues of how meaningless numbers and scores may be, subject to misinterpretation. She writes:
This year has been a weird one for me and cancer. In the ER, we see cancer patients pretty infrequently. The occasional chemotherapy with fever, but that’s about it. I think the oncologists try hard to keep the patients out of the ER — to everybody’s benefit.
But this year, I’ve had a weird rash of cases where I’ve made primary diagnoses of cancer in the ER — several times over and over and over again. In ten years I don’t think I’ve made as many cancer diagnoses as I have this year alone. Just very strange.
Unfortunately, it came home to roost. My wife was diagnosed with breast cancer last week. Read more »
*This blog post was originally published at Movin' Meat*
The Chicago Tribune reports on mammogram marketing tactics being used across the U.S. — some of it apparently to “woo women back to the imaging room” after confusion over conflicting advice about breast cancer screening.
Yes, the tactics include “mammogram parties” offering chocolate fondue, massages, beauty consultations, wine, cheese, roses, and weekend-getaway spa packages. But there’s another side to this, the Tribune reports:
Simply inviting women to “mammogram parties,” could send the wrong message, said Lynne Hildreth, department administrator of women’s oncology at Moffitt Cancer Center in Tampa. …”Mammograms are a medical test, and to treat it like a haircut overlooks that there are very real risks,” said Hildreth. “It’s not the same risk as getting hit by a car, but there’s a real risk of getting a false positive, which means a biopsy work-up, time off work, sleepless nights waiting for test results and a nagging in the back of the mind that never goes away. If we put a woman through that with no medical basis, it’s irresponsible.
We reviewed four stories on the Swedish mammography study that appeared in the journal Cancer last week. Three of the four stories gave a pretty clear indication that there were methodological concerns about the Swedish research (of the four reviewed, only HealthDay offered no such hint):
• 4th paragraph of AP story: “The new study has major limitations and cannot account for possibly big differences in the groups of women it compares.”
• 1st paragraph of LA Times blog story: “Critics charged that the study was poorly designed and potentially vastly misleading.”
• 2nd sentence of NY Times story: “Results were greeted with skepticism by some experts who say they may have overestimated the benefit.”
But none of the stories did a very complete job of explaining those potential limitations. Because of the confusion that must be occurring in the minds of women — especially those in their 40s — this is a time in which journalism must rise to the need and do a better job of evaluating evidence and helping readers make sense of what appear to be conflicting findings.
I was in Chapel Hill, North Carolina, when the study was published and had the chance to talk about it with former U.S. Preventive Services Task Force member, and a recognized thought leader on issues of prevention and especially of screening tests, Dr. Russell Harris, Professor and Director of the Health Care and Prevention Concentration of the University of North Carolina (UNC) School of Public Health. Read more »
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