Doctor tells FDA .... mammogram won't spot cancer....

It irks me when they mention the concern for false-positives and unnecessary biopsies due to MRI. Having gone misdiagnosed for 1 year due to docotor stupidity and no access to MRI, I would rather 50 false-positives than the false-negative that I had. Just my 2 cents.

geewhiz -- As I read it, this radiologist was saying that a mammogram that shows dense breasts should be a signal to do further testing, in order to rule out a cancer that can't be detected on a mammo.

lindasa, IMHO, your reading is correct... but some radiologists disagree.  This, which I copied from the article, is the sort of thing that really irks me.  It's the official position of the "American College of Radiology" (ACR) which is the main professional credentialling organization to which radiologists belong:

+++++quote begins+++++++

"The American College of Radiology, in a position statement, said that it recognizes that greater breast density leads to lower sensitivity for mammography. While information on breast density is helpful for physicians, it said, 'It is less clear how the typical patient would interpret or understand the same information.' "

"Patients with dense breasts might demand additional alternative forms of screening, such as ultrasounds or MRIs, which would lead to more false positives and unnecessary breast biopsies.

"If the alternate forms of screening were not covered by insurance, that might lead to 'an unfortunate disparity' between those who could pay for it themselves and those who couldn't. And women without dense breasts might develop a false sense of security, the policy statement said."

+++++quote ends++++++

Okay, so let me see if I have this straight...  The ACR doesn't want radiologists to inform women that they have dense breast tissue, because it isn't known how those women would "interpret or understand" that information.  So, they think we're too frickin' stupid to be able to figure out what it means, or whether it's significant.  And, apparently, they aren't willing to explain it to us.  Isn't that sort of like a doctor declining to tell a patient she has high cholesterol, because it isn't clear how she will "interpret or understand" that information?

And, if we do happen to find out that our breast tissue is dense, we might "demand additional screening" (duh!).  What if people with high blood glucose were not told about it, for fear they might "demand additional screening" to see if they were diabetic?  Egads!  Can you imagine the chaos!

And, naturally, all that "additional screening" those hysterical women would demand, "would lead to false positives and unnecessary breast biopsies"...  which, of course, seems to be the medical profession's greatest concern.  They're not worried about false-negative results, overlooking a suspicious area, or failing to detect a malignancy.  They think it's more important to avoid false-positives and "unnecessary" diagnostic procedures.  I guess they never met a negligence suit they didn't like?  (That does explain why the ACR doesn't want to change official policy.  Malpractice lawsuits are based on failure to follow "standard of care.")

But, I think it's the last paragraph of that quote that sends me over the edge:  the ACR's concern about "unfortunate disparity" and a "false sense of security." 

Okay, let's assume that some insurance companies will cover the "additional screening", and others will not.  Faced with denial of coverage, some patients will have the resources to pay for the screening out-of-pocket; while others will not.  But, to avoid "an unfortunate disparity" between the insured and the un/under-insured, or between those who can pay out-of-pocket and those who cannot, the ACR would withhold information about breast density from all women having mammograms.  My mind is flooded with absurd analogies.

And, finally, gosh... suppose some women who are told their breast tissue is not dense become complacent, and "develop a false sense of security."   We wouldn't want to give them any false assurance that their risk of cancer might be lower than anyone else's, would we?  You know, sort of like sending a woman a form letter, telling her that her most recent mammogram showed "no evidence of cancer"?

[Excuse me while I go in the other room and barf.]

We need radiologists to get onboard with this breast-density thing -- to agree that, for women with dense breasts, policies need to change, and to agree on a protocol for reporting mammographic density.  (There is no consensus protocol right now.)  At the very least, women with dense breasts should be informed of the condition, so we're aware of it.  To deny us this critical information about our bodies is like not telling someone she has high blood pressure, because she might not know how to interpret the information and it might cause her undue anxiety.  Sheesh.

[Sorry this is so long... longer than usual, even.  Must have hit a nerve.]

otter

Otter, thank you for that breakdown.  Now I know WHY I wasn't told the full details, and I agree, it makes me want to vomit.  Would I have asked for more testing?  Oh yes, most definitely.  And yes, I would have been in that group that could afford to pay it out of pocket, creating an "unfortunate disparity."  I guess taking care of my health is no longer my right.  I truly feel sick.

Wugh.

This just confirms the need for patients to request copies of the radiologist's report as well as the doctor's notes of each visit.  It has been fascinating what I learned from reading those reports, such as that I have dense breasts!

The guidelines and most discussion is about 'which tests and how often to shedule it' .  That is about finding cancers in a large populaiton of women.  My only concern is finding any cancer in my body.  Public health officials worry about the former.  Our job is the look out for ourselves.

My surgeon recommended two mammagrams a year, so I asked for an MRI and mammogram, which is what I am doing.  When I had a biopsy for what turned out to be necrotic fat tissue the radiologist encouraged me to stick with an MRI and mammogram progaram.  She suggested even when I go to once a year to have a mammo one year and an MRI the next. 

Boo