Impact of a priori medical decisions on screening for breast cancer

Article Abstract:

Physicians often perform breast biopsy (surgical removal of a tissue sample) following mammography (breast imaging exams) even when a lesion (a section of altered tissue) discovered in a mammographic image is probably benign (non-cancerous) rather than malignant (cancerous). A growing and widespread fear of adverse legal action by patients against their doctors has prompted an increase in what some experts call a national trend of excessive mammograms and breast biopsies. The likelihood of legal action (such as malpractice suits) continues to have an impact on medical practice, such as the choice of biopsy following a suspicious mammographic examination. Research has shown that the frequency of breast screening examinations, such as mammography and breast biopsy, is increasing for non-medical reasons; physicians use extra breast exams as a means of demonstrating professional competency and good judgement in order to strengthen their positions as defendants in malpractice lawsuits. Yearly mammographic exams for females over the age of thirty-five are advocated by many medical authorities, but opinions differ as to what circumstances call for breast biopsy. In cases of distortions of breast structure or the existence of microscopic calcified breast tissue, biopsy and mammographic follow-up is considered standard medical protocol. However, experts also seek to demonstrate circumstances when biopsy is not required. The author suggests that in mammographic exams yielding suspicious findings in women aged forty to forty-nine years (e.g., an image that suggests the remote possibility of cancer) an initial follow-up mammogram should be performed within three to four months. If the patient's medical condition remains stable the next examination should be performed nine months after the second mammogram. The author presents these findings as a professional medical opinion, rather than as a clinical finding based on a scientific evaluation of the problem. In conclusion, he suggests that a benign lesion should probably be followed up by a series of additional mammograms, rather than a breast biopsy exam.

Evaluation, Physicians, Medical personnel, Malpractice, Medical malpractice, Breast, Medical malpractice insurance, Breast biopsy

---

Early breast cancer: detection of recurrence after conservative surgery and radiation therapy

Article Abstract:

Research has shown that treatment of early breast cancer (stage I or II) with conservative surgery and radiation therapy is as effective as total mastectomy for achieving local control and improving survival. It also has the added cosmetic advantage of preserving much of the breast. Further surgery can be performed if this mode of treatment fails. However, early detection of such failure is crucial. This study looks at the role mammography (breast X-ray) plays in follow-up of patients who undergo conservative surgery and radiation therapy to treat breast cancer. Mammograms and clinical records were reviewed of 48 women who had undergone this treatment and who were later thought to have recurrence of cancer and underwent further biopsies. Twenty-four of these patients had recurrent cancer confirmed by biopsy. Twenty-three of the 24 recurrences were directly related to the initial disease. Mammograms had been obtained in 22 of the 24 patients within four months of diagnosis of the recurrence. New masses were seen in 5 of the 24 patients. Physical examination of the 24 patients resulted in 17 positive findings. Mammograms were positive in the seven patients with negative physical examinations and physical examinations were positive in nine of the cases in which mammograms were negative. Both were positive for eight of the patients. This indicates a complementary nature of the two exam modes. Malignant breast cancer turned up less frequently in the patients who were positive only on mammography than in those only positive on physical examination. These results indicate both mammography and physical examination are important in detecting recurrence of breast cancer. The optimal frequency of mammography is not clear, but once every six months is presently recommended. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Recurrence (Disease)

---

Professional quality assurance for mammography screening programs

Article Abstract:

Quality assurance (QA) is a major area of concern for physicians. Great strides have been made in quality assurance of the technical aspects of mammography, a radiographic screening and diagnostic technique for breast cancer. Equipment, technical performance, and procedures have been improved to limit exposure to X-rays while ensuring the diagnostic accuracy. However, QA is also important on the professional side of mammography. In the end, any diagnostic technique is limited by the capabilities of the physician using it. In the May 1990 issue of Radiology, Sickles et al. report on their QA methods for a screening mammography program. They use a formal medical audit procedure to maintain the highest quality in their program. The audit includes quantitative data from demographics, initial and follow-up findings, and data separated for each radiologist. The demographic information is probably not necessary for clinical purposes. The important findings are in terms of false-positive and false-negative results. The audit method reviewed by Sickles and colleagues probably misses many false-negative findings. Follow-up data are expensive and time consuming to get. A random follow-up sampling and a national registry for breast cancer would enable more accurate determination of false-positive findings. Individualizing the data for each radiologist is a very important tool in assuring quality. Quality thresholds for performance have been set locally in the past, but national standards will be needed in the future. QA programs are designed to provide an ongoing education to practitioners and to maintain and increase performance standards. Their implementation is highly recommended and they should focus on professional as well as technical aspects of the service provided. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Medical care, Quality management, Medical care quality

Similar abstracts:

• Abstracts: Advances in medical imaging. Identification of K-ras mutations in pancreatic juice in the early diagnosis of pancreatic cancer
• Abstracts: Technical considerations for prophylactic mastectomy in patients at high risk for breast cancer. Penetration of prophylactic antibiotics into peritoneal fluid
• Abstracts: Surgical decision making for large bowel cancer metastatic to the liver. Acute cervical spine trauma: correlation of MR imaging findings with degree of neurologic deficit
• Abstracts: Impact of medical hospitalization on treatment decision-making capacity in the elderly. Health care decisions among elderly long-term care residents and their potential proxies
• Abstracts: Stage II seminoma: results of postorchiectomy irradiation. Diabetic fibrous breast disease. Prognostic factors for recurrence and cosmesis in 393 patients after radiation therapy for early mammary carcinoma

This website is not affiliated with document authors or copyright owners. This page is provided for informational purposes only. Unintentional errors are possible.