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
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."
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.