The focus of this month’s issue—women’s health—is very important to me for two reasons, one of which is because I’m a woman; second, as the editor of Medical Imaging, it’s my job to help keep you on top of the issues most relevant to you.
I interviewed Nancy Elliott, MD, FACS, for our Q&A (page 20) and found it to be thought provoking and eye opening. As one of the country’s leading breast surgeons, Elliott is an activist for women’s health and the fight against breast cancer. She founded the Montclair Breast Center, in Montclair, NJ, 15 years ago and provides the most up-to-date breast technology available to women today. Elliott expressed some rather daring but quite sensible ideas for ways to decrease breast cancer’s mortality rate.
The good news is that with medical imaging technologies—specifically MRI and ultrasound—physicians are finding tumors sooner, and many of Elliott’s patients don’t have to go through the trauma and cost of chemotherapy.
Part of the problem, however, is that many payor organizations don’t cover the cost of ultrasound and MRI, despite the fact that 30% of breast cancers aren’t visible on a mammogram. Another issue is that in most facilities (90% in fact), mammograms are not reviewed by dedicated breast imagers. Since breast imagers spend all of their time interpreting mammograms, ultrasounds, and MRI scans, isn’t it only natural that they would be that much better at detecting breast cancer? As Elliott puts it, “Studies have shown that when judging open-heart surgery, the hospitals that do more open-heart surgeries have better outcomes.” However, mammography—a very poorly reimbursed study—is one area where practices lose money; hence, they often cannot afford dedicated breast imagers.
So what’s the solution? Elliott has a few interesting ideas, and I’m eager to hear your opinions on one in particular. She has proposed that only dedicated breast imagers be allowed to read mammograms and other breast-imaging studies. This idea, as interesting as it sounds, is a difficult one to enforce, as staffing shortages have allowed for only 10% of women to have their mammograms read by a dedicated breast imager. Still, I tend to agree with Elliott that, ultimately, this mandate would save lives.
If this concept is our future goal, what steps does the industry need to take in the meantime? For starters, we need more dedicated breast imagers, a designation that requires full-time focus to reading breast-imaging studies and can require an additional 1-year fellowship. Second, because mammography requires some of the highest malpractice insurance, breast imagers need to be supported by the medical community and recognized as treasures within it. Third, Elliott suggests that every facility designate a radiologist as its mammography and breast-imaging expert. This person, who would dedicate all of his/her time to breast-imaging studies, could attend conferences and other events for continuing education, and be involved in the selection of appropriate technology and equipment.
Finally, and perhaps most important, the MQSA (Mammography Quality and Standards Act) should have stronger, more demanding qualifications for mammography facilities to acquire a license. Specifically, the MQSA requires that to be a certified interpreting physician, he/she must have “at least 3 months of documented formal training in the interpretation of mammograms and in topics related to mammography” as well as “a minimum of 60 hours of documented medical education in mammography.” Further, in terms of experience, the MQSA requires that these physicians interpret “at least 960 mammographic examinations during the 24 months immediately preceding the date of the facility’s annual MQSA inspection.” To compare, Elliott’s breast imagers (both of whom are radiologists with additional breast-imaging training) each read 400 to 500 mammographic examinations per month. I’ll let the numbers speak for themselves.
In closing, yes, the past 5 years have seen the breast cancer mortality rate decrease for the first time ever, but not by much. It’s time to make some changes. Perhaps this solution is a step in the right direction. I look forward to your thoughts.
Andi Lucas
Editor
