BREAST CANCER: Lawsuits Scare Off Radiologists
An FDA panel recommendation last week to approve GE Medical Systems' digital mammography system could not have come at a better time for radiologists, who have been barraged by malpractice lawsuits for missing breast cancer on traditional film mammographies, USA Today reports. According to the Physician Insurers Association of America, missed breast cancer is the number one basis for malpractice claims filed in the "errors of diagnosis" category, prompting many cautious radiologists, who already receive "relatively low" reimbursement rates, to refuse reading screenings. Radiologists and breast cancer advocates argue that mammography has been "oversold" to the public as a "foolproof system," when in fact it misses 5% to 17% of breast cancers. While about one-third to two-thirds of these tumors are visible on mammograms in retrospect, one-third to two-thirds are still undetectable. Some fear that the number of radiologists dropping mammography could cause a shortage, forcing women to endure long waits or travel distances for screenings. UCSF breast imaging specialist Edward Sickles said, "It's getting harder and harder to attract young people into the business" (Rubin, USA Today, 12/21). Digital imaging could improve radiologists' ability to read mammograms because it "enhance[s] the contrast between normal tissue and abnormalities in the breast" (Rubin, USA Today, 12/21).
In other breast cancer news, Vanderbilt University School of Medicine researchers have found that women with the benign breast disease epithelial hyperplasia lesions lacking atypia (EHLA) may be at greater risk for invasive breast cancer. The study, published in the December 15 issue of the Journal of the National Cancer Institute, shows that women with EHLA who lack the transforming growth factor beta (TGFb) receptor on more than 75% of their breast cells were more than three times as likely to develop breast cancer. TGFb is a chemical messenger that regulates cell division by attaching to a receptor on the surface of the breast. But when women lack that receptor, cells continue to divide, causing cancer. Dr. David Euhus, assistant professor of surgical oncology at the University of Texas Southwestern Medical Center, called the research "important," noting that "it shows us how cells may take the brakes off of proliferation" (Sisson, Medical Presscorps/Detroit Free Press, 12/21).