© 2004 by Oxford University Press
© 2004 Oxford University Press
CORRESPONDENCE |
Re: Decreasing Women’s Anxieties After Abnormal Mammograms: A Controlled Trial
Correspondence to: Daniel B. Kopans, MD, Massachusetts General Hospital, Avon Foundation Comprehensive Breast Evaluation Center, Wand Ambulatory Care Center, Ste. 240, 15 Parkman St., Boston, MA 02114 (e-mail: kopans.daniel{at}mgh.harvard.edu)
Anyone reading the paper by Barton et al. (1) on decreasing anxiety associated with false-positive mammograms should consider the following points. First, as explained below, there is a greater potential for false-negative mammograms when immediate interpretations are rendered than when they are not. Second, the authors have documented what is intuitively obvious, i.e., we would all like to receive the results of our medical tests immediately, and our anxiety levels increase when we have to wait for results. Third, Barton et al. provided no frame of reference for their findings. For example, it would be useful to know the level of anxiety associated with cervical cancer screening, which has a false-positive rate as high as, if not higher than, that for mammography screening and the results of which are typically delayed by weeks. Fourth, rushing the interpretation of mammograms may increase the risk of errors. For example, in a double-reader study performed at Massachusetts General Hospital, we found that a slow and methodical reader detected 36 of 39 cancers, whereas a second reader who double read the mammograms quickly found three cancers that were missed by the slow reader but missed eight cancers that were detected by the slow reader (2). Fifth, we have found that when we provided immediate interpretations of mammograms, women became impatient in the waiting room as they waited for their results and pressured the technologists who pressured the radiologists who then rushed the interpretation of the studies (Kopans D, Hall D, McCarthy K, Staffa M: unpublished observations). Sixth, although our results suggest that double reading of mammograms increases the breast cancer detection rate while reducing the false-negative rate, since it is not a service that is re- imbursed by most insurers, facilities that provide free double reading of mammograms need to be very efficient for this approach to be economically feasible. Double reading of mammograms is not feasible when immediate mammogram interpretations are provided. Seventh, since 1990, the death rate from breast cancer in the United States has decreased concomitant with the onset of breast cancer screening. However, the stresses involved in interpreting mammograms and the increased risk of malpractice accusations against radiologists for failing to diagnose breast cancer have contributed to the diminishing number of radiologists who are willing to interpret mammograms. Immediate interpretation of mammograms is likely to increase the stress for the radiologist. If such additional burdens are placed on radiologists, they may ultimately refuse to read mammograms, and breast cancer screening and its benefits may become unavailable for women.
We should be educating women that immediate interpretation of mammograms is not in their best interest. Instead, radiologists should be encouraged to take their time with slow and careful reading of mammograms (and to participate in double reading of mammograms, if possible). The anxiety of waiting for a mammographic test result is unfortunate, but it is certainly not equivalent to dying from breast cancer because of a rushed review that missed the lesion.
REFERENCES
1 Barton MB, Morley DS, Moore S, Allen JD, Kleinman KP, Emmons KM, et al. Decreasing women’s anxieties after abnormal mammograms: a controlled trial. J Natl Cancer Inst 2004;96:529–38.
2 Hulka CA, Mrose H, McCarthy K, Hall DA, Whitman GA, Kopans DB, et al. The value of double reading in screening mammography. Presented at the 80th Scientific Assembly and Annual Meeting of the Radiological Society of North America. Chicago, IL, November 27–December 2, 1995.
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J Natl Cancer Inst 2004 96: 1187.
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