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Southwest Imaging Consultants, Inc. Elk City, OK 73644
In his article "The Missed Breast Cancer: Perceptions and Realities" [1], Dr. Berlin raises important issues that should be addressed. First, informed consent that contains mammography audit data should be obtained before performing mammography. This would have two effects: only radiologists who have results comparable with those in the literature would ultimately interpret mammograms, and patients would not be surprised when cancer is missed. Second, Berlin's salient points about mammography should be addressed in an instructional video that all women who undergo mammography should be forced to watch before the examination. A quiz at the end of the video should be mandatory. An educated public is less likely to sue if it understands the test is less than 100% accurate.
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Rush North Shore Medical Center Skokie, IL 60076
I thank Dr. Beville for his thoughtful albeit provocative suggestions. I agree that an educated public is less likely to sue radiologists for failure to diagnose breast cancer if it understands that mammography is less than 100% accurate. As I indicated in my article [1], I believe that radiology organizations such as the American College of Radiology and the American Roentgen Ray Society should consider the possibility of undertaking efforts that would educate the public about the true rates of sensitivity and accuracy in mammography and also about the reality that early diagnosis of breast cancer does not necessarily guarantee a cure. The content and format of such an educational program should be determined by these organizations. An informational videotape such as that envisioned by Beville that could be made available to all women before undergoing mammography is certainly one potential format.
Conducting periodic audits of mammographic accuracy among radiologists is indeed an excellent method of ensuring that only radiologists who maintain acceptable expertise interpret mammograms. These kinds of audits are essential for the implementation of performance improvement programs, but whether the results of these audits ought to be disclosed to the public is a controversial question that warrants further evaluation and discussion by the radiology community.
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