Confirming the trend we reported on Oct. 3: “A worsening shortage of providers is threatening women’s access to mammograms, says a major new report that found long waits for the breast X-ray in parts of the country. …Fewer radiologists are specializing in breast imaging because of long hours, low reimbursement, heavy regulation and fear of lawsuits,” according to the Institute of Medicine study. In addition, as readers try to lean over backwards lest they be accused of overlooking an ambiguous result, the false-positive rate in mammogram results has nearly doubled since the 1980s, according to the report, which in turn “leads to costly, unnecessary repeat testing as well as the anxiety that women often cite for skipping mammograms.” (Lauran Neergaard, “Scientific advisers urge increased access to mammograms”, AP/San Francisco Chronicle, Jun. 10; “Advisers urge greater mammogram access”, AP/CNN, Jun. 10; report, “Saving Women’s Lives: Strategies for Improving Breast Cancer Detection and Diagnosis“).
The medical blogs have been all over the story: MedRants, Cut to Cure, MedPundit. Last month radiologist Thomas Boyle (“CodeBlueBlog”) deplored some of the economic and regulatory pressures working to kill mammography practice (“Mammactivists Killing the Mammogram”, May 12, see also Jun. 11), and was no less scathing about the legal pressures:
A mammogram is an inherently limited study with relatively low sensitivity and specificity. Unfortunately, the public does not understand these limitations because the exam has been oversold as a diagnostic modality (We are told this is for the public’s “own good?). As a result, people have a difficult time understanding why breast abnormalities are “missed” or “misinterpreted” during routine mammography. Personal injury lawyers ruthlessly take advantage of this dilemma by scavenging mammograms involved in breast cancer cases. They prey on this ignorance by holding radiologists to impossible standards bolstered with retrospective analyses of mammograms done by venal physicians in their stable of “experts”. As a result, mammography is the single highest liability risk for radiologists (and the second highest risk in all of medicine). For a $15 reading fee, radiologists can face multi-million dollar lawsuits.
More: PointOfLaw, Dec. 14.
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Gladwell on mammography
The New Yorker’s Malcolm Gladwell is out with an article on the very imperfect art/science of mammogram-reading. MedRants focuses in on the litigation implications; there’s an enormous leeway to second-guess the readings of radiologists and others who …