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    Can You Trust Your Mammogram?

    Screening Snafus continued...

    Why it matters: Getting a regular mammogram is key to finding breast cancer early. Five-year survival rates drop from a high of 98.1% for early, breast-only tumors to 27.1% for advanced cancer that has spread to distant organs.

    What you should do: When you call for an appointment, ask if there's a breast-imaging specialist on staff. If not, shop around, advises Diana Miglioretti, Ph.D., a researcher with the Group Health Center for Health Studies in Seattle. "I'd go to someone who has been interpreting screening mammograms for at least 10 years."

    Follow-up Foul-ups

    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 tissue.

    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.

    Surgical Biases

    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.

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