CodeBlueBlog: i-Mammo Part II: Breasts, Lies and Videotapes

*****************

THE AWARD WINNING MEDICAL WEBLOG

April 2005

Sun	Mon	Tue	Wed	Thu	Fri	Sat
					1	2
3	4	5	6	7	8	9
10	11	12	13	14	15	16
17	18	19	20	21	22	23
24	25	26	27	28	29	30

About

Links

http://
Search Popdex:
For Dictionary: Type In Word Then Click "Partial" Submit Button

Webster's Online Dictionary
The Rosetta Edition™

English Non-English
Blogroll Me!
DISCLAIMER This is a personal web site, reflecting the opinions of its author. It is not a production of my employer, and it is unaffiliated with ANY hospital, medical center, medical practice or other physicians. Statements on this site do not represent the views or policies of anyone other than myself. The information on this site is provided for discussion purposes only, and are not medical recommendations. I offer no guarentee as to the accuracy of anything stated and the information here is at times, highly speculative and does not constitute advice to/not to diagnose or treat. Any personal medical issues the reader may have should be referred immediately to the reader's private physician and under no circumstances should anyone delay, change, or alter any medical treatment or planned treatment or diagnosis based on anything read on this site. Under no circumstances does any herein contained information represent a medical recommendation.
Best of the Web
Logial Fallacies
Word of the Day
Quackwatch
Undisclosed Location
Grand Rounds Archive
Blogstreet
Daypop Top 40
Carnival of the Vanities
Link to hosts and updates
BLOGGER NEWS NETWORK
Breaking News in the Blogosphere
http://www.neolibertarian.net/blogs/
This work is licensed under a Creative Commons License.

Blog powered by Typepad

Subscribe to this blog's feed

« i-Mammo: The Mammogram You Never Had | Main | GRAND ROUNDS AND SICK PARROTS »

i-Mammo Part II: Breasts, Lies and Videotapes

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.

Posted by Doctor CBB on April 15, 2005 at 02:37 PM | Permalink

Comments

I think you are missing their numbers, and using much worse ones.
15% more, would mean that for every 100 cancers found previously, that they now find 115 cancers.
Your numbers would have 15 cancers out of 100 mammograms in addition to whatever was found originally.

Posted by: Jhn1 | April 15, 2005 at 05:44 PM

Numbers please??? All these dire consequences of government and legal involvement remain unquantified and are simply claimed to exist without any citation. Please provide numbers as to the number of closed clinics, mammographies left uninterpreted.

Interestingly, all the problems you point out if "solved" would mean more $$ for radiologists. Surprise!!!

If reimbursements from medicare are so low, STOP taking medicare patients. Since you're such a wonderful radiologist (a fact you like to harp upon), I'm sure you can make a living serving exclusively the privately insured or self-insured. Problem solved

Posted by: Dr. Caligari | April 15, 2005 at 07:53 PM

Jhn1: Of course, you are correct, and in rereading how I phrased the 15%, it was misleading. I'll fix that in the next post. Thanks.

Posted by: CodeBlueBlogMD | April 15, 2005 at 09:29 PM

Reader Caligari:

Sorry. I assumed most people had read about and heard about the closing of mammography clinics and services (like NYU's outpatient women's mammography center)on the front pages of The New York Times and The Wall Street Journal, along with most of the major media. It's not a far trip on Google to find lots of references to this problem.

I can forward you the email for the emergency mammography legislative task force set up last year in Tallahassee, Florida, to deal with precisely this problem.

And congratulations on discovering my motive and seeing through this ruse of mine...about the $$, I mean. I guess it's all out in the open now. I've flayed this fish in an effort to start a groundswell that would eventually lead to a HUGE increase above the $15 per mammogram radiologists now get.

I'm thinking if I could get $18 per interpretation, I'd really be living high.

Anyway, thanks for the input. I'll try not to play that harp that seems to be so irritative.

Posted by: CodeBlueBlogMD | April 15, 2005 at 09:44 PM

CodeBlue ...

Don't waste the finger tips on "Dr." Caligari ... if you check out http://chaplin.nu/archives/000316.html you will see that she/he rather aggressively attacked Dr. Chaplin for his choice of medicine careers.

Reading the responses over there, I thought she/he was just anti male doctors ... but, after seeing her/him over here ... I'm thinking she's/he's just anti doctor.

Keep informing us all. You do a great job!

(PS ..if you're ever just looking for a subject ..can you do one on Arnold Chiari Malformation?)

Posted by: Peggikaye | April 16, 2005 at 12:05 AM

Here, here to CBB! I'm a radiologist and I've read breast studies for years. I read that in some recent year, like 2002 or 2003, 4400 breat imaging centers CLOSED. You got that right! No one has time to double read bec. the available readers are too busy just trying the read the ones they've got. Reimbursement is terrible, fed regulations are everywhere, quality control is constant, more so than in any other type of imaging, suits and/or threats of suits are everywhere. Everything about the breast is difficult; it's difficult to image; the pathology is very difficult; you have to take a large percutaneous specimen to get a diagnosis, much larger than any other organ; mammography is unpleasant, and has to be performed every year for just ONE type of cancer, vs. a blood lab profile which can exclude many things. Women hate it. Radiologists hate reading them, for the most part. Women are frightened. The stats are misleading, by the way, in that the highest liklihood 1:9 is in the last decode of life, the 90's, when cancers are easiest to treat. Some progress slowly, some so fast that early diagnosis is useless. Frivolous suits are rampant; one woman had her diagnosis delayed by SIX WEEKS, went on to die--very aggressive tumor in a pre-menopausal woman--and her family sued and won. You have to keep numbers on the number of cases you read, the number of continuing medical credits you earn, and your true-true/true-false positive readings-your accuracy. No other branch of medicine is so stringently regulated. The work is tedious and usually does not involve much new technology. Digital is fine but very expensive, $100,000. per work station the last time I checked, and required constant maintenance by the vendors, so one must keep one's standard machines up and running for the dig. downtime. I am not sure about reimbursement for dig mammos. Other areas of imaging are far more interesting and lucrative. No easy answers in sight.

Posted by: Kate Killebrew, MD | April 16, 2005 at 04:26 PM

Thank you for the blog about mammograms.

I am amazed at how behind the times the medical administrative field is in using technology.

I think it good to have a set of human eyes to examine the test, and a computer as well.

Wondering, would you write something about the attempt to legalize sillicon breast implants again?
Also even the FDA's own website advises that every implant will eventually leak.
Even saline implants use sillicon for the shell.
That mammograms can cause implants to rupture.
That the temperature of the human body can cause the implant shell to degrade.

If you write about this, it will bring greater visibility to this issue.

I love your blog, I am a fan of yours since your writing about Terri Schiavo.

Thank you for all that you do.

Posted by: Joyce | April 17, 2005 at 12:36 PM

Do silicon implants cause cancer and other diseases?

http://www.pbs.org/wgbh/pages/frontline/implants/cron.html

Will computer aided diagnosis increase the number of women who suffer unnecessary biopsies? What if the doctor disagrees with the computer. Must a biopsy be done to avoid possible legal action?

Posted by: concerned | April 17, 2005 at 03:04 PM

Did you send your grand rounds submission in to grrlscientist yet?

(just trying to help her out by plugging it where I can (grin) she needs more submissions)

So .. anyone reading this ... send your submissions for grand rounds to [email protected]
by tomrrow! She needs them! Sooner better than later.

Posted by: Peggikaye | April 17, 2005 at 04:03 PM

Very interesting.

Posted by: purple_kangaroo | April 18, 2005 at 03:37 PM

Mammography:

Is this a service that needs to go "cash", completely outside any insurance......with the image downloaded to another part of the world outside the reach of the tort bar?

Separate the technical part of the service, which can't leave the USA, from the professional part of the service which can now be sent anywhere on the planet?

Or, if one does not want to send outside the USA, send the image to a state that has real tort reform, get the image read there?

Posted by: arf | April 18, 2005 at 07:25 PM

The only thing missing is a federal law forcing radiologists to read mammograms.

Posted by: Galen | April 19, 2005 at 07:17 PM

一本道　無料動画一本道　無料動画一本道　無料動画一本道　無料動画一本道　無料動画一本道　無料動画一本道　無料動画一本道　無料動画一本道　無料動画一本道　無料動画

Posted by: 一本道　無料動画 | December 30, 2005 at 09:50 PM

Posted by: Linda | September 09, 2006 at 10:04 AM

Posted by: Tomeczek | September 19, 2006 at 06:03 AM

Cheap Flights, Hotels, Airline Tickets, Car Hire & Holiday Packages
http://www.travelxtension.com
http://www.flightssydney.net
cheap flights to sydney

http://www.flightsjohannesburg.net
cheap flights to johannesburg

http://www.flights-bangkok.com
cheap flights to bangkok

http://www.flights-beijing.com
cheap flights to beijing

http://www.cheap-flight-thailand.com
cheap flight to thailand

http://www.cheaplastminuteflight.net
discounted last minute flight

http://www.cheap-international-flight-ticket.com
cheap international flight ticket

http://www.cheap-business-class-flight.com
cheap business class flight

http://www.flights-new-zealand.com
cheap flights new zealand

http://www.poland-flight.com
cheap poland flight

http://www.cheap-flights-dubai.com
cheap flights to dubai

http://www.cheap-flights-prague.com
cheap flights to prague

http://www.flights-russia.com
cheap flights to russia

http://www.cheap-flights-japan.com
cheap flights to japan

http://www.cheap-flights-china.com
cheap flights to china

http://www.cheap-flights-thailand.com
cheap flights thailand

http://www.flights-riga.com
cheap flights to riga

http://www.flights-johannesburg.com
cheap flights to johannesburg

http://www.flights-romania.com
cheap flights to romania

http://www.robotscheepflights.com/
Robots Cheep Flights

http://www.robotsairlineflights.com/
Robots Airline Flights

http://www.simplyflyanywhere.com/
flights to anywhere

Posted by: alan | October 16, 2006 at 07:10 AM

http://www.worldgreatrecipes.com
Recepies Recipes Collection

http://www.recipes-cookbook.com/
Recipes Cookbook Holiday Recipes Crock Pot Recipes

http://www.recepies-cookbooks.com
Crock Pot recepies Chicken recepies Slow Cooker recepies

http://www.recepies-cookbook.com/
pork chop chicken dinner cookie recepies

http://www.recipies-cookbooks.com
Recipies Cookbooks Recipes Cookbooks

http://www.cookbooks-recipies.com
seafood chili thanksgiving recipies Cookbooks

http://www.recipies-recepies.com
meatloaf recipie salsa tapas pot roast recepies

Posted by: alan | October 16, 2006 at 07:11 AM

Posted by: gandi | October 23, 2006 at 04:10 AM

I think what you are doing is great!!! I want to use your color scheme at my sites...

Posted by: Erin | June 02, 2007 at 05:51 PM

I just don't have much to say right now, but I guess it doesn't bother me. Basically nothing seems worth thinking about. Nothing notable happening these days. Shrug. Not that it matters. My mind is like a void. I've basically been doing nothing , not that it matters. More or less nothing going on. I guess it doesn't bother me. Not much on my mind.

Posted by: boat in ontario sale used | August 10, 2007 at 06:04 AM

Health Value Travel is a growing global phenomenon that is helping to reshape the larger health care industry. To learn more about this exciting trend, visit the Health & Medical Tourism site.

Health Value Travel

http://www.healthmedicaltourism.org

Posted by: Prakash Arige | August 10, 2007 at 08:15 AM

Help the homeless down the street and persuade them to look for work

Posted by: sam | October 08, 2007 at 06:29 PM

PangaeaMedicine’s extensive Medical Provider database allows you to research hundreds of medical procedures available to you.
http://www.pangaeamedicine.com/treatment.php

Posted by: Medical Tourism Treatments | May 29, 2008 at 01:17 AM

Mammograms should be available to every woman, along with smear tests and any other screening that could catch cancer early. I think most women aren't even really told about them or encouraged to have them - certainly in school (UK) it's never mentioned. A regular check-up every few years would be a great idea so i think the government should at least raise awareness so more women would ask their doctors about the options available.

Posted by: Sylvia Ring | June 10, 2008 at 04:09 AM

It's fairly simple to obtain a payday advance. Generally speaking, a proof of employment is all that is needed to obtain these short-term loans.

Posted by: payday loans nlvnv | August 23, 2008 at 05:32 AM

The comments to this entry are closed.

2004 WINNER: BEST CLINICAL SCIENCES MEDICAL WEBLOG

What People Are Saying

"Dr. Boyle is a man of strong views and good will...read the weblog."
Brad DeLong-- Semi-Daily Journal
"My New Favorite Internet Obsession"
cripes, suzette
"Marvelous Medical Blog"
Ambivalog
"Entertaining and lluminating"
Counterpunch Magazine
"Enjoyable Weblog"
Alexander Cockburn
"I have found a new medical blog, and a blogging hero."
Liz Ditz-- I Speak of Dreams
"Your Blog Rocks!"
Allyson Dyar-- DyarStraights.Com
"A remarkable blog."
Eric Scheie – Cultural Values
"Good thoughts"
E. Moritz-- Life Liberty and the Pursuit of Happiness

CodeBlueBlog

health care also health·care (hlthkâr) n. :efforts made to maintain or restore health especially by trained and licensed professionals -- usually hyphenated when used attributively

*****************

THE AWARD WINNING MEDICAL WEBLOG

April 2005

About

Recent Posts

Archives

Links

i-Mammo Part II: Breasts, Lies and Videotapes

Comments

2004 WINNER: BEST CLINICAL SCIENCES MEDICAL WEBLOG

What People Are Saying

Around The Hospital

Nonmedical Consultants

Science

Sources

Technorati

	Webster's Online Dictionary The Rosetta Edition™
	English Non-English