December 19, 2017
In Mammography, History Matters
The most powerful breast cancer indicator on a mammogram is the growth of a mass observed from a previous mammogram1. When it comes to mammographic imaging procedures:
- Reducing the number of ionizing radiology procedures that a patient undergoes to only the most critical exams, while extracting pertinent information from past exams, helps minimize a patient’s radiation exposure.
- Accessing previous exams gives physicians greater visibility into any abnormalities by providing more comparable imaging information.
Why, then, are prior exams vastly under-utilized?
All too often, the imaging exchange process is inoperable or inefficient. Physicians hit roadblocks accessing and attempting to view previous medical imaging procedures that originated outside their organization – and patients often don’t understand the importance of facilitating the process, or are simply challenged to obtain previous records in advance of their next imaging appointment.
Even though the American Cancer Society recommends that patients obtain previous mammograms and provide them to their radiologist if they were completed at a different location2, approximately a quarter of mammogram patients arrive to their appointment without prior images available for comparison3-6.
Dr. Richard Szucs, radiologist and legislative chairman of the Virginia chapter of the American College of Radiology, believes that “radiologists and doctors [should] work closely together for the best fit, taking into consideration the patient history and prior studies. Particularly in the case of cancer, it’s important to closely compare with previous scans to measure growth or shrinkage7.”
This collaboration helps reduce false positives and “recalls,” where patients are contacted after a breast screening for additional testing due to potentially abnormal findings. Every additional screening comes with its own share of costs: a patient’s time away from work/family, an often-painful testing procedure, and financial burdens to the patient undergoing the testing; not to mention the emotional impact of days and weeks spent wondering if they have cancer. The providers and payers also incur additional and potentially unnecessary costs in the process as well.
In an article early last year, Kathryn Pearson Peyton, MD, Mammosphere founder and Chair of the Women’s Health Advisory Board at lifeIMAGE, found that the average recall rate for mammography screening in the U.S. averages 10 percent8, compared with a selection of European countries, whose recall rate averages between 1-3 percent, due in large part to physician access to a national network of prior images9,10.
Change is happening, albeit slowly. Patients are coming to understand the value of embracing advocacy in health care, including accessing and acting on their medical imaging procedures and reports. Recently, a patient in Virginia, Tanya Headspeth, shared her story about what empowered her to make a series of proactive health care choices throughout a long and arduous battle for her health. Headspeth has metastatic breast cancer that spread to her bones and liver, and has done extensive research to assure the greatest quality of care throughout her treatment process, including managing and even interpreting her own imaging records. She explains that the research and care choices she makes are critical, and in her case, “it’s a matter of life and death.”
With more readily-available prior exams on record, we reduce the barriers that impede patient consumerism, empower patients toward better self-care, and pave a path for more efficient image interpretation and better results. In addition, they expedite the clinical decision making for appropriate medical management for better outcomes.
- Understanding Your Mammogram Report. American Cancer Society, 2017. Accessed via: https://www.cancer.org/cancer/breast-cancer/screening-tests-and-early-detection/mammograms/what-does-the-doctor-look-for-on-a-mammogram.html
- Mammograms. Radiology Info, 2017. Accessed via: https://www.radiologyinfo.org/en/info.cfm?pg=mammo
- Roelofs AA, Karssemeijer N, Wedekind N, et al. Importance of comparison of current and prior mammograms in breast cancer screening. Radiology.2007 Jan;242(1):70-7.
- Kleit AN, Ruiz JF. False Positive Mammograms and Detection Controlled Estimation. Health Serv Res. 2003 August; 38(4): 1207–1228).
- Sickles EA. Successful methods to reduce false positive mammography interpretations. Radiol Clin North Am 2000; 38(4):693–700; and Radiol Clin North Am48 (2010) 859-578.
- Bassett LW, Shayestehfar B, Hirbawi I, Obtaining previous mammograms for comparison: usefulness and costs. AJR Am J Roentgenol.1994 Nov;163(5):1083-6.
- When it comes to MRI and CT scans, some patients may have to be more like consumers. The Virginian Pilot; December 4, 2017. Available: https://pilotonline.com/news/local/health/patients-as-consumers-woman-with-metastasized-breast-cancer-asks-questions/article_26682686-6ed1-5352-9171-8fb04d4a6957.html
- Rosenberg RD, Yankaskas BC, Abraham LA, Sickles EA, Lehman CD, Geller BM, Carney PA, Kerlikowske K, Buist DSM, Weaver DL, Barlow WE, Ballard-Barbash R. Performance Benchmarks for Screening Mammography. Radiology; October 2006; 241: 55-66.
- Fracheboud J, de Gelder R, Otto SJ, et al. National evaluation of breast cancer screening in the Netherlands 1990-2007. Rotterdam, the Netherlands: andelijk Evaluatie Team voor bevolkingsonderzoek naar Borstkanker; 2009.
- Smith-Bindman R, Chu PW, Miglioretti DL, Sickles EA, Blanks R, Ballard-Barbash R, Bobo JK, Lee NC, Wallis MG, Patnick J, Kerlikowske K. Comparison of Screening Mammography in the United States and the United Kingdom. JAMA. 2003;290(16):2129-2137.
Vice President of Product and Market Development