Breast cancer ID'd more accurately by docs who see more scans
February 22nd, 2011
12:01 AM ET

Breast cancer ID'd more accurately by docs who see more scans

The more mammograms your doctor interprets every year, the better your doctor becomes at determining whether there’s really breast cancer present, according to a new study to be published in the journal Radiology.

The study finds that doctors who interpret a higher yearly volume of mammograms have fewer false-positives, meaning they call fewer patients back in for additional testing.

Perhaps surprising to many people, low volume and high volume radiologists were equally good at catching breast cancer; it’s just that low volume doctors sounded more false alarms so to speak.

“We found that radiologists who interpreted more mammograms a year had clinically and statistically significantly fewer false-positive findings – without missing more cancers,” says Diana S.M. Buist, Ph.D., MPH, the study leader, in a written statement. “That means radiologists with higher ‘interpretive volumes’ could identify the same number of cancers, while making fewer women come in for extra tests that showed they did not have cancer.”

Radiologists in the United States are required by the Food and Drug Administration to interpret at least 960 mammograms in two years. But that could change. In Europe and Canada, the required number is five times higher.

“Based on these data, it would be beneficial if U.S. volume requirements could be increased to 1,000 or 1,500 screening mammograms per year,” says Buist.

But some radiologists, for example those practicing in rural areas, simply do not see enough patients to reach high volumes. Raising the required number of mammograms a radiologist has to interpret every year could potentially put those doctors out of practice – and their patients at risk.

“Some women may not be able to get care, because if you take out the radiologist and the small practices where they’re currently going to get this screening, there may not be another facility nearby that they have access to” says Dr. Stamatia Destounis, managing partner, Elizabeth Wende Breast Care, LLC. The end result could be fewer patients getting screened for breast cancer.

That means implementing a policy aimed at reducing anxiety and saving money – $1.6 billion is spent every year in extra testing after a false-positive – could actually result in more deaths from breast cancer.

Dr. David Dershaw, professor of Radiology at Cornell University Medical College, disagrees with the study’s policy recommendation. “I would not argue for raising the number beyond what it is,” he says. “The difference in the call-back rates was really not tremendous.”

The study also finds that radiologists who interpret diagnostic mammograms in addition to initial screening mammograms had fewer false positives. This study used information from 783,965 screening mammograms interpreted by 120 radiologists over five years.

soundoff (10 Responses)
  1. mig

    This would be logical, if a doc is not used to reading scans, when they see something that they are unsure of they are going to assume that it is potentially harmful and are going to want to do further testing. Docs that look at these more often are going to recognize spots as being benign, and not do further testing. Not sure a test was necessary, but, hey, when there is government grant money to spend....

    February 22, 2011 at 02:29 | Report abuse | Reply
    • mig

      I meant to say study*

      February 22, 2011 at 02:30 | Report abuse |
  2. Lapinski

    Unfortunately it doesn't help you pay the medical bills that are now even higher because your scans from the new machine.

    February 22, 2011 at 05:10 | Report abuse | Reply
  3. Almd

    Lapinski....no but it helps avoid a frivolous lawsuit

    February 22, 2011 at 07:34 | Report abuse | Reply
  4. Aaron Scott

    Using the principles of "Deliberate Practice," it seems to me that it would be relatively easy for the medical society to round up, say, 10,000 scans a year (perhaps by requiring that all such scans be submitted to a central database). Those scans could then be used as training and testing for med school students and doctors, enabling them to train using real-world scans, and to immediately know whether they made the right diagnosis or not.

    At some point, more and more doctors are going to figure out the difference between a positive and false-positive, making minute corrections to their methods, etc.

    Further, we could do this with all sorts of medical advice, enabling doctors to practice over and over and over on making the right diagnoses for whatever ailment or disease.

    February 22, 2011 at 07:39 | Report abuse | Reply
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