Can You Trust Your Mammogram?
If your screening mammogram is abnormal or you have a lump, the next step is
often a diagnostic X-ray, which takes magnified close-ups of the suspicious
The news: In theory, diagnostic mammograms should be easier to
interpret than screening ones because the doctor knows where trouble may be
lurking. Yet the largest study analyzing how well radiologists do on these
critical exams found they missed 21 percent of cancers on average. The real
shocker was the range: The top performer found every tumor, while the worst
missed an astonishing 73 percent. Doctors affiliated with academic medical
centers did best: They correctly diagnosed 88 percent of cancers.
Why it matters: Missing a tumor at this step could mean a delay in
diagnosis — possibly a dangerous one, if a tumor isn't detected and treated
before the cancer has spread.
What you should do: As with screening X-rays, the doctor who reads
your diagnostic X-ray should be someone who specializes in mammograms, says
Miglioretti, who led the study. Unless you live in a rural area, you should be
able to find such a specialist no more than an hour or two away. "It's
worth the drive," she says.
The biggest decision many women face when they're diagnosed with breast
cancer is whether to have a mastectomy (removal of the entire breast) or a
lumpectomy (only the tumor and surrounding tissue are cut out). In many cases,
breast-conserving surgery, including lymph node testing and follow-up
radiation, has the same lifesaving benefits as mastectomy. Yet your surgeon may
not explain the options and consequences clearly or evenhandedly.
The news: Clinical guidelines developed by leading organizations
favor breast-conserving surgery because it's less drastic. That's true whether
you live in Augusta, ME, or Augusta, GA. Yet a review of 800,000 patient
records found that while 70% in the Northeast had breast-sparing surgery, only
58% of those in the South did (the numbers for the West and Midwest were 63
percent and 61 percent, respectively). The review didn't look for a why,
but study leader Jack Sariego, M.D., professor of surgery at Temple University,
notes that the more rural South likely has fewer radiation facilities and fewer
academic medical centers to promote surgical advances.
Beyond your zip code, the type of surgeon and hospital you choose may affect
the recommendation you'll receive. Doctors who treat a lot of breast cancer or
who work in cancer centers or academic medical centers suggest lumpectomy more
often than general surgeons in the community. Surgeons trained after 1981 are
also more likely to recommend a lumpectomy than older doctors, past research
from the University of North Carolina at Chapel Hill has shown.
Why it matters: In a survey of 1,132 women who had either a
lumpectomy or a mastectomy, almost half indicated they did not understand the
risks and benefits of their choice.