Ive long been an avid fan of The New York Times, but recently Ive become dismayed. My dismay comes from the pair of articles penned in late June by Michael Moss that basically highlights the poor practices and improper training of a few radiologists in reading mammograms and subjects the many to ridicule and doubt. (Spotting Breast Cancer: Doctors are Weak Link, June 27; Mammogram Team Learns From Its Errors, June 28) Moss says radiologists also are unwilling to have their practices monitored by Amercian College of Radiology (ACR). The government was taken to task as well based on its failure to police breast imaging under the Mammography Quality Standards Act.
Moss has done mammography, radiology, healthcare and woman a grave disservice in his inaccurate portrayal of mammographys shortcomings. The truth be told, mammography is far from a perfect science or even art, but the breast cancer death rate has fallen 20 percent since 1989, according to the ACR. The argument that screening isnt working is moot. In 2001, an estimated 192,200 women were diagnosed with breast cancer, while about 39,600 women died from the disease.
These articles also come at a time when the total number of mammograms provided to women 40 and older rose about 15 percent (1998-2000), according to the U.S. General Accounting Office. This reflects the enlarging population of women over 40 (growing by 1 million per year), as well as increased utilization by women. In 2000, 64 percent of women over 40 had a mammogram in the last year compared with 58 percent in 1998.
Im all for reporters serving as consumer watchdogs, because great truths can be pulled from these investigations. Yet Moss pieces show hes done little research into mammography and the dawning technologies of CAD and full-field digital mammography, having barely touched on them. Women would be excited to know that studies place FFDMs sensitivity as 100 percent, along with faster throughput and higher productivity, and that one CAD study released this spring places CAD increasing a radiologists sensitivity by 91.4 percent which means more cancers detected.
Mammography does have its crises. The number of centers offering screening mammography is dwindling. ACR said 675 healthcare facilities that provide mammography services have closed their doors in the last year, about 40 percent of them for financial reasons. Declining reimbursement is sapping imaging centers and hospitals offering screening mammograms, despite the fact that most insurers require centers provide them. The House of Delegates of the American Medical Association in July called for increased payments for mammograms as well. And while many complain about the Medicare reimbursement rate for mammography, many managed care plans pay only about 60 percent of Medicare rates. Regulation by the ACR also brings in additional costs of tens of thousands of dollars per facility per year.
Mammography ranks first in the number of radiology malpractice claims, with awards getting larger into the multi-million dollar category. As youll see in a sidebar to the reimbursement story in this issue (DI-62), radiology malpractice rates have jumped 50 to 400 percent based on medical malpractice insurance companies withdrawing coverage and going bankrupt, along with the stock market slump.
My hope is that radiologists, mammographers and equipment vendors take all the current adversity and mobilize to better this greatly needed technology. We must ensure access to all women who need a mammogram to be read by a skilled radiologist.
Mary C. Tierney, Editor