iMammo: The Mammogram You Never Had
An article in several parts
Yesterday, in Part I:
The Music of Digital Mammography
- What is digital (computerized) mammography?
- How does digital mammography compare with traditional (x-ray film) mammography?
- What are the advantages of digital; mammography?
Today, in Part II:
Breasts, Lies, and Videotapes:
The Iron Triumvirate and the Dirty Secret of Mammography
I've Got A Secret
Shhhh…What is the dirty little secret of mammography? Double reading picks up 15% more cancers.
A double reading means that a mammogram is looked at twice, by two different radiologists.
This “secret” is well known in the imaging community, and was established in the early 1990’s when a study of 11,000 mammograms confirmed that: Double reading detected 15% more cancer cases. The author's conclusion to that study?
"Independent double reading does significantly increase sensitivity of mammography screening."
If having a mammogram interpreted twice prevents 15 more women -- on top of every 100 found -- from having their breast cancer remain undiagnosed, why aren't all mammograms double-read?
Answer: It's impossible.
Have you heard of the "crisis" in mammography? What is this crisis? Well, since every woman over the age of forty needs a mammogram every year, there is a never ending -- and right now constantly enlarging -- pool of women needing mammography. There are tens of millions of mammograms that need to be done every year. However, increasingly, doctors, hospitals, and clinics are dropping the procedure from their repertoire of imaging studies. It is getting harder and harder to get routine mammograms scheduled, done, interpreted and acted upon in a timely fashion. Eh? How can that be?
The Confederacy of Dunces
There are three large, important, forces of influence that shape the face of mammography in the United States. Ten seconds to guess them.
Did you say the millions of women over age 40? Wrong.
Did you say physicians, scientists, or mammographers? Wrong.
The ruling Iron Troika of mammography consists of: The government, Mammactivists, and Torters. These are the groups that, in reality, have the most influence over how mammography gets done -- or not done -- in the United States. The "crisis" in mammography is directly related to the perverse influence of these three groups on that procedure.
In a previous post I wrote about Mammactivists Killing the Mammogram. Burdensome, expensive, superfluous and redundant anti-market legislation promulgated by "disease-specific" breast cancer lobbyists and approved by weak-kneed legislators has created thousands of pages of regulations controlling the entire process of mammography, from the building the machine is in, to the developing fluid used in the photographic process.
To comply with these regulations (the laws, that is) is expensive and time-consuming. These costs -- added to all the other fixed overhead of a women's center -- make mammography a money loser.
Medicare -- run by the federal government -- has, over the years, slashed the reimbursement for obtaining and interpreting mammograms under the claim that if the examination is too expensive, fewer women will obtain it.
Add to these factors the ever present Torters (go here if you are unfamiliar with this beast) who have turned mammography interpretation into one of the greatest liability risks in all of health care, and...voila! A crisis exists.
Low reimbursement, burdensome federal regulations and the constant threat of lawsuits make mammography an undesirable task for any radiologist. As a result, only a small percentage of radiologists will interpret mammography. In many communities it is hard enough to find one radiologist who will interpret mammography, let alone another radiologist to reread the thousands of mammograms done in any given center each year.
Ineluctable Cell Logic
This is a breast cancer cell. Some of these cells double every 120 days. So a cancer that is barely visible and highly curable -- say 3mm -- today, could have a dramatically worse prognosis in a year, at over 2 cm.
The Iron Troikites all claim that what they do is for the "good" of women.
- Mammactivists claim that their legislation helps protect women from substandard equipment, facilities and doctors
- The government claims that by forcing lower reimbursements, they are allowing more women access to mammography
- Torters snap away about how liability lawsuits protect women from bad doctors
What, actually, are the consequences of their good intentions? The "Iron" in their title stands for irony because, the consequences of these good intentions are:
- Radiologists are being driven away from women's imaging
- Clinics are closing their doors
- Mammograms are not double-read which would detect 15 more cancers in addition to every hundred breast cancers found...meaning, if these women are lucky their missed cancers (that could have been detected this year) will only grow "a little" before next year's mammogram
- New, more expensive technology-- such as digital mammography and MRI of the breast -- is adopted slowly and limitedly
In the next installment I'll discuss how digital mammography and the breast MRI fall victim to the final irony of the Troika.
a free power leveling of 12 hours or 100 gold bonus from gmlvl.com your any new order in Oct.No bots ! no delay ! fast and safe powerleveling and gold delivery.
New special 1-60 power leveling, price $56.99 with lvl40 mount
Simple 60-70 powerleveling, price $58.99,with 2000 gold and 375 first aids
Posted by: rbtone | October 14, 2008 at 02:19 AM
Do you also need to buy goods Guangdao foot shopping and worry about acid? wholesale
And discount china wholesale stores also did not
have time Car video
to do some MP3 player
shopping With MP4 player
more and block mp4 watches
the development Men's outerwear
Women's outerwear
Mens outerwear
skin care products
wholesale mp3
wholesale mobile phones
digital camera wholesale
consumer electronics of networks, Internet psp accessories
shopping is wedding dresses
also more wholesale silver jewelry
convenient, now you wedding dress
only need bluetooth headset
to Ceramic tile
sit in memory cards
front of the wholesale digital cameras
computer, drinking wholeslae clothing
coffee, visit wholesale clothing
the website can be wholesale furniture
elected to their gps devices
favorite wholesale mp3
products, we Memory Card
can be here for Memory Stick
you More wholesale furniture
choices, many wholesale
practical, durable, wholesale atv
affordable, attractive wholesale electronics
merchandise, wholesale jewelry
there's the same wholesale handbags
for you, we gps devices
will provide wholesale shoes
you wholesale electronics
with quality wholesale t shirts
service! I hope wholesale digital cameras
you can Wholesale jewelry
here in wholesale jewelry our shopping pleasure to welcome you!
Posted by: luos | October 21, 2008 at 08:13 PM
Share Dvd tools with Mac users!
Here is the result I want to share with Mac users:
1) Cost/Performance: Everybody wants to gain more with less money.
2) Speed: Nobody wants to waste too much time waiting.
3) Profile: Of course we want our software can convert all kinds of video formats.
4) Personal Demands: For example, someone just wants to convert part of the DVD video, or others want the special output video format like PSP compliant forms and etc.
5) Easy to use: we want to make things easy.
http://www.dvdcreatormac.com/
http://www.dvdcreatormac.com/dvd_burner_for_mac.htm
http://www.dvdcreatormac.com/dvd_copy_for_mac.htm
http://www.dvdcreatormac.com/dvd_ripper_for_mac.htm
Posted by: Lemom | October 23, 2008 at 03:01 AM
Special WoW PowerLeveling 1-(55-60), $56.99,with lvl30 Mount,200G,Create a DK and hit to lvl60(optional)4-5days; Fast 60-70 powerleveling,$59.99,with 2000 gold,375 first aids;Fast powerleveling 1-70,$99.99 1.Lvl225 riding skill 2.500 Gold;3.375points First Aid 4.Flight Paths 5.two professions to 300 points. Cheap powerleveling 70-80,$69.99, 1000gold, 450 FA,cold weather flying skill,5days. www.gmlvl.com
Posted by: rabbit | January 20, 2009 at 03:04 PM
Restaurant pagers(http://www.ace-karaoke.net/service-call-system.htm
) boasting innovation, quality, and value. Increase your bottom line with restaurant pagers.
Posted by: English songs | May 11, 2009 at 11:22 PM
designer handbag---http://www.supplybags.com/wholesale-handbags.html
Posted by: bridal gown | May 13, 2009 at 05:11 AM
If I have money ,I will buy [url=http://www.worldchen.com/wholesale-rings_162.htm]Stainless steel Ring Wholesale[/url] Stainless steel Bracelet
Posted by: Designer Handbag | May 19, 2009 at 05:32 AM
The visit was useful. Content was really very informative. From http://www.chennaiflowerplaza.com
Posted by: nancy | August 22, 2009 at 02:12 AM