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Auburn Radiologic Associates Auburn, NY 13021
After reading Leonard Berlin's article in the May issue, "Breast Cancer, Mammography, and Malpractice Litigation" [1], I was struck with the thought that interpreting mammography is like playing Russian roulette. If a patient can win a large dollar amount in a suit for a 6-week delay in the diagnosis of breast cancer, then as radiologists we need to reevaluate our recommendations for follow-up mammography. The current standard of care advocates close mammographic follow-up (6 months) for probably benign (BI-RADS category 3) lesions [2]. A small percentage of these lesions (perhaps 1–2%) will prove to be malignant. This means, according to current litigation, that a radiologist could be sued in those cases for medical malpractice and would be expected to lose the case. Why should a radiologist take the risk in recommending close mammographic follow-up? Indeed, why should a radiologist take the risk in interpreting mammography and breast sonography in the first place? Although I believe that the current system works well with regard to patient care and treatment, it does not succeed in protecting the physicians who are diligent in providing breast care for women.
Does this mean that as radiologists, we should recommend biopsy in all patients with BI-RADS category 3 lesions? Or do we just "bite the bullet," do the right thing for the patient, and take the chance that we will be sued for a delayed diagnosis of breast cancer? I do not have the answer. I do know that in my own practice, with the availability of stereotactic breast biopsy, I am more likely to suggest a breast biopsy than follow-up mammography for BI-RADS category 3 lesions. I also find myself looking at the calendar more frequently and calculating how long until retirement so that I can excuse myself from these irritating situations.
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Rush North Shore Medical Center Skokie, IL 60076
I share Dr. Tersegno's poignant and heartrending lamentation, and I suspect that most AJR readers do as well. As indicated in my article [1], delay in the diagnosis of breast cancer continues to be the most common allegation in malpractice lawsuits filed against all physicians, and allegations of missed diagnoses of breast cancer on mammography continue to be the most common cause of malpractice lawsuits filed against radiologists. Indeed, patients can win large dollar awards in malpractice litigation alleging as short a delay as a few weeks in the diagnosis of breast cancer. No wonder in this milieu of burgeoning malpractice litigation and rising professional liability insurance premiums radiologists express bewilderment, exasperation, frustration, and depression. No wonder increasing numbers of practicing radiologists are giving up mammographic interpretation, fewer radiology residents are enrolling in mammography fellowships, and growing numbers of mammography facilities in the United States are closing their doors (Lucey L, personal communication).
Why should radiologists take the risk in recommending mammographic follow-up rather than immediate biopsy for any mammographic finding that raises even the remote possibility of malignancy? Why should radiologists take the risk of interpreting mammography and breast sonography in the first place? Why should radiologists take the risk of "doing the right thing" by recommending follow-up studies when their training and experience warrant their doing so, when they know that if the lesion later turns out to be malignant and a malpractice lawsuit is filed, an expert radiology witness for the plaintiff will probably emerge to testify that the failure to recommend biopsy in the first place was a breach of the standard of radiologic care? Why should not radiologists keep looking at the calendar and calculating how soon they can retire from radiologic practice?
Alas, Tersegno does not have the answers to these questions, nor do I.
As my article mentioned, the American College of Radiology has stated its intention to develop a campaign that will educate the public about the limitations as well as the benefits of mammography. We can only hope that such endeavors, coupled with legislative tort reform, will restore a measure of reason to what is now a malpractice mindset that is injurious to both the public and the radiology community.
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