Existential crisis … seriously?

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 - Lisa Fratt - Portrait
Lisa Fratt, Editor

This week, a single study set my blood boiling. A false-positive screening mammogram was linked with long-term psychosocial harm, trauma and existential crisis, in a study published March 18 in Annals of Family Medicine. Again, I ask, seriously?

Richard Duszak, MD, CEO of the Harvey L. Neiman Health Policy Institute, framed the question more appropriately in an early morning Tweet: False positive #mammogram? Existential crisis. False negative? #BreastCancer.

Most of us in the radiology community have become accustomed to the regular bashes on screening mammo. Perhaps this group should be screened less often; that group faces a higher risk of false positive, and on and on.

Most breast imagers acknowledge that mammography is an imperfect screening exam. But despite the impressive arsenal of adjunct exams—screening ultrasound, breast MRI, molecular breast imaging—screening mammography is best we have. Quite simply, mammography saves lives.

I’ve had a false-positive mammogram. More friends than I can count on both hands have experienced a similar results. We grumble, hold our breath and present for the next step. By no stretch of the imagination is the scenario on par with an existential crisis.

The research smacks a bit of the Victorian propensity to diagnose women with female hysteria. It’s bunk.

But a real crisis could ensue if too much is read in the results, if primary care providers and women are deterred from screening exams because of trumped-up fear of psychosocial harm.

Yes, real data are needed to improve screening mammography. Science may show how to better target the exam. I’ve no doubt we will learn which breast cancers are indolent and which require aggressive treatment. But overplaying the harms of screening mammography represents a harm in itself.

However, the study can be leveraged as a conversation starter to let women and primary care providers understand that a false-positive mammogram is fairly normal and likely insignificant. And as the American College of Radiology and Society of Breast Imaging noted in their response, it can spur breast imagers to provide faster scheduling and improve patient-centered service and communication. Unlike the Annals study, this outcome does no harm.

Have a terrific weekend! Today is the final day for Health Imaging's one-question survey about practice models. Please respond.

Lisa Fratt, editor