WASHINGTON – Mammography remains the best tool to help reduce breast cancer mortality rates,but there are fewer places for women to get the test and fewer people to interpret the results,a study released Thursday says.
The report,“Saving Women's Lives,” by the Institute of Medicine and National Research Council says its findings highlight serious obstacles to early detection and diagnosis of breast cancer.
“We answered the question,‘Which approaches are most likely to save the most lives?'” said Dr. Martin Abeloff,director of the Johns Hopkins Cancer Center and study researcher. At a press conference,Abeloff called mammography “the most powerful tool at our disposal.”
Mammography helps reduce breast cancer mortality because it is the most effective means of detecting and diagnosing breast cancer in its early stages,the report says.
But,as Abeloff put it,“Mammography is not perfect.”
Studies show women do not receive mammograms because they misperceive their breast cancer risk. This is especially common among older women who receive mammograms less often as they advance in age – at just the time when their risk increases,Abeloff said.
The report,the result of an 18-month study,also says mammography is facing what Alberoff called a “crisis in capacity,” with the number of mammography facilities declining by 8.5 percent in the past three years.
There is also a shortage of breast imagers,the report says. Only 20,000 radiologists in the U.S. can interpret mammograms,and only about 2,000 of those specialize in breast imaging.
That there are so few medical personnel capable of reading mammograms is due to several factors,including fear of lawsuits – misdiagnosis of breast cancer is the leading cause of medical malpractice – and low reimbursement for long hours,Alberoff said.
In an effort to reduce the workloads of radiologists,the report recommends changing mammography procedures to reflect practices used in the United Kingdom. In the U.K.,non-physicians trained in breast imaging,pre-screen or double read mammograms under the supervision of a breast-imaging specialist,the report says.
New technology could also improve mammography procedures.
Dr. Etta Pisanto,director of breast imaging at University of North Carolina hospitals,said doctors are studying several new procedures that could improve breast cancer detection and diagnosis.
Two studies are testing the effectiveness of magnetic resonance imaging and ultrasound to locate breast cancer in high-risk women. Both studies will be completed in five years. Pisanto heads a study testing the benefits of digital mammography,the results of which should be available in one year,she said.
One of the most important areas in which technological improvement is needed is determining risk,Alberoff said. “But it's not an exact science,” he said.
To determine risk,doctors use factors such as age and sex. A second set of factors,including family history and a woman's age at the time she first gave birth,aren't as accurate at predicting which women will get breast cancer,Alberoff said,which means there is much work to be done in identifying what the determining factors actually are.