Breast imagers: Radiologys Sisyphus?

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Lisa Fratt, Editor

Evidence that screening mammography is clinically valuable and cost-effective continues to accrue. Yet, much like Sisyphus, the mythical Greek figure condemned to push a boulder uphill, and eternally watch it roll down, breast imagers have battled the denigration of mammography for three-plus decades. Like Sisyphus, the end of the debate continues to elude radiologists.

The most recent data were presented at the Breast Cancer Symposium Sept. 8-10 in San Francisco. It reinforced the point breast imagers have emphasized for years. That is, screening mammography detects cancer earlier, resulting in less aggressive, less costly treatment.

A retrospective study of nearly 6,000 women under the auspices of the Michigan Breast Oncology Quality Initiative demonstrated that patients whose tumors were detected through palpation were more likely to undergo mastectomy (46 percent) than those found by mammography (27 percent). Women whose tumors were diagnosed by palpation were also more likely to undergo chemotherapy (22.7 percent) than those diagnosed by mammography (15.7 percent).

Yet, skeptics continue to question the modality. A pair of editorials in the September issue of Radiology debated the significance of overdiagnosis. While a group of researchers suggested that screening mammography has a minor effect on mortality and breast imaging may cause more harm than benefit, breast imagers argued that claims of overdiagnosis are inflated.

The ongoing debate has confused both referring physicians and women, leading a group of editorialists to urge radiologists to take a lead role in communicating the value of screening mammography to women in an editorial published online Aug. 11 in Academic Radiology.

Indeed, communication can play a key role in stymying plummeting participation in screening mammography, according to experts in the September Health Imaging & IT cover story.

Given the duration of the debate, and the high moral and clinical cost of confusion about the role of screening mammography, at least one radiologist is contemplating extreme measures. Michael N. Linver, MD, director of mammography at X-Ray Associates of New Mexico in Albuquerque is considering suing the government for depraved indifference. Linver explains, “[The government] admits that women's lives will be lost. The court of law may be the only recourse at this point. A lawsuit would provide a public venue to debate the issue and bring it back into the public eye."

How is your organization contending with the ever-mounting challenges of screening mammography? Let us know.

Lisa Fratt, Editor