U.S. mammographers fall short in comparison with Britain
Tuesday, October 21st 2003, 12:00 am
News On 6
CHICAGO (AP) _ American doctors do twice as many tests to find the same number of breast cancer cases as physicians in Britain, reflecting inferior mammogram training and greater fear of malpractice suits in this country, researchers say.
The study found that U.S. radiologists declare many more mammogram results uncertain or suspicious, compared with their British counterparts, and that as a result, American women with and without cancer undergo at least double the number of follow-up tests, such as biopsies.
The higher U.S. ``recall'' rate would make sense if the overall American cancer detection rate were higher. But the study found that cancer was detected in just under six cases per 1,000 mammograms in the United States and just over six per 1,000 in Britain, nearly identical rates.
The researchers said the study illustrates the need for better mammogram training and oversight to improve U.S. radiologists' ability to interpret the results.
``Very clear and specific standards and targets need to be set for interpretation of mammography,'' said lead author Dr. Rebecca Smith-Bindman of the University of California at San Francisco. ``Radiologists who perform outside acceptable ranges need to be told, `That's not acceptable' and given an opportunity to learn how to better perform.''
The study appears in Wednesday's Journal of the American Medical Association.
Dr. David Dershaw, president of the Society of Breast Imaging and director of breast imaging at Memorial Sloan-Kettering Cancer Center in New York, said the study does not reflect all U.S. breast cancer screening programs.
He criticized the researchers for downplaying an important difference between U.S. and British cancer detection rates: More cases of early, curable breast cancer are detected in the United States.
Still, he acknowledged that British doctors who do mammograms generally are more specialized than those in the United States, some of whom focus on other areas of radiology.
In the United Kingdom, most mammogram specialists read more than 7,000 such tests yearly, compared with about 1,000 among U.S. doctors who do mammograms, Smith-Bindman said.
Also, fear of malpractice suits over undetected cancer is much greater in the United States, prompting doctors to go overboard sometimes in requiring additional tests, Smith-Bindman said.
Britain also has a quality control program focusing on rates of cancer detection and recall rates. Doctors who fall below a minimum standard are subject to increased scrutiny.
Also, Britain has organized professional development training for mammogram specialists, detailing ``the kinds of things you should call back for'' more testing and ``the kinds of things you shouldn't,'' Smith-Bindman said.
Continuing medical education is required for American radiologists but ``almost never targets specific recall or cancer detection rates,'' the study said.
More than 30 million mammograms are done each year in the United States.
The research is based on data on women 50 and older who underwent 5.5 million mammograms in the United States and United Kingdom from 1996 through 1999.
Among women ages 50 to 54 undergoing their first mammograms, 14.4 percent in one large U.S. nationwide screening program were called back for additional tests, versus 7.6 percent of those in the British program.