Mammograms Provide Most Potential To Detect Breast Cancer, Save Lives, Institute of Medicine Report Finds
Despite the recent development of a number of new technologies that aim to improve screening methods for breast cancer, mammograms still offer "the greatest potential to save lives for the immediate future," and medical experts need to find ways to expand and improve their use, according to a new Institute of Medicine report, the Chicago Tribune reports. The report, "Saving Women's Lives," is the work of a panel of experts appointed in 2002 by IOM to identify ways to reduce the impact of breast cancer through early detection (Peres, Chicago Tribune, 6/11). The report found that women increasingly are experiencing difficulty obtaining mammograms. Currently, between 62% and 65% of women in the United States who should be getting mammograms are doing so, and many are forced to wait up to five months for an appointment. The report attributes the difficulties to a lack of screening facilities and a shortage of radiologists in the field. Nationwide, the number of mammography screening facilities dropped from 9,400 in 2000 to 8,600 in 2003, an 8.5% decrease (Fox, Reuters/Philadelphia Inquirer, 6/11). At the same time, the number of radiologists is growing by 2% per year while the workload is growing by 6% per year. The report cited low reimbursements and high risk of medical malpractice lawsuits as two reasons why few medical students are choosing to specialize in radiology (MacDonald, Hartford Courant, 6/11). The authors of the report made several recommendations to address mammogram access problems and reduce the number of false positives, which they say could save about $100 million per year (Chicago Tribune, 6/11). These include:
- Training physician assistants to interpret mammograms, which would relieve the burden on radiologists, improve thoroughness of examination and expand screening facilities' capacities. Physician assistants would serve as pre-screeners or "double-readers," providing back-up for physicians, not primary screening (Schaefer Munoz, Wall Street Journal, 6/11);
- Developing computer-aided detection to back up the complex process of reading mammogram X-rays (Reuters/Philadelphia Inquirer, 6/11);
- Notifying women when they are due for a government-paid mammogram;
- Centralizing mammogram reading sites (Hartford Courant, 6/11);
- Developing ways to better assess a woman's risk of breast cancer to tailor screening strategies by frequency and need -- one possibility is to develop a blood test for commercial use that measures the hormone estradiol; and
- Teaching doctors to more effectively communicate risk to patients (Chicago Tribune, 6/11).
Edward Penhoet of the Gordon and Betty Moore Foundation and chair of the panel that issued the report said in a statement, "Improving and increasing the use of current mammography technology is the most effective strategy we have right now for further reducing the toll of breast cancer" (Reuters/Philadelphia Inquirer, 6/11). Dr. Etta Pisano, chief of breast imaging at the University of North Carolina and an author of the report, said, "Mammography saves lives, and we need to figure out a way to get it to more patients more uniformly" (AP/New York Times, 6/11). Robert Smith, director of cancer screening at the American Cancer Society, said the report emphasizes "some very, very worrisome signs" in the breast cancer screening system and highlights the need to find effective solutions. Dr. Cheryl Perkins, senior adviser to the Komen Foundation, said, "Overall, this is a very comprehensive report that does an excellent job of outlining barriers and possible solutions" to the problems in the breast cancer detection system (Hartford Courant, 6/11). However, the American College of Radiology said it opposes the use of physician assistants to help read mammograms because of safety concerns. "We should not lower the bar so that women have a perception of increased access only to find that the access is to inferior care," James Borgstede, chair of ACR's board of chancellors, said. He added that allowing physicians assistants to interpret mammograms could lead to higher malpractice insurance premiums (Wall Street Journal, 6/11).
NBC's "Nightly News" on Thursday reported on report. The segment includes comments from Dr. Martin Abeloff of Johns Hopkins University's Oncology Center, Dr. Michael Cohen of Memorial Sloan-Kettering Cancer Center and Carolina Hinnestrosa, executive vice president for programs and planning for the National Breast Cancer Coalition (Bazell, "Nightly News," NBC, 6/10). The complete segment is available online in Windows Media.This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.