Here are some ideas on how we might reduce the incidence of metastatic breast cancer, by making high-quality mammography available to all women:
1. Modernize all breast imaging facilities. All should comply with the Mammography Quality Standards Act and Program (MQSAP) of 1992.
2. Ensure that radiologists, technicians and other BC screening workers are up to date: requirements for continuing medical education in an academic, unbiased (non-pharma or biotech setting), should be strict. We depend on practitioners’ current knowledge of breast imaging methods, breast biopsy techniques, hygiene, information technology (IT) and patient privacy laws.
3. Implement digital mammography in all screening facilities; Digital images allow radiologists to adjust the contrast, magnify or otherwise highlight areas of concern, to better analyze potential lesions without subjecting patients to extra x-rays.
4. Supplement mammograms with sonograms of the breasts. These inexpensive tests can help radiologists discern cysts and other benign lesions from malignant tumors. In some situations, a radiologist inspecting a sonogram can spot a small solid abnormality that’s missed in a mammogram. In principle, this low-rad combo – of digital mammography and breast sonography — would increase sensitivity and specificity of breast cancer screening.
(5.) Consider transmitting digital images to breast screening centers, so that expert radiologists can review every woman’s films.
As Sue, a woman who’s had breast cancer told me last month: “You don’t want a radiologist who’s just looked at someone’s broken foot examining your mammogram.”
She’s right: Expertise can make a huge difference in clinical outcomes.
I would be interested in your opinion on the actual improvements by digital mammography, in which the apparatus is anatomically better arranged, and no squeezing is involved. This was accompanied by much bragging by the operators as to how comfortable the procedure is with their new equipment.
Not so much that I want to compare the new equipment with the older practically rip your breast off your chest wall variety. But I am wondering if the new machines have overdone things, and maybe the digital technology would give even better images if they squeezed just a little bit.
Hi Gaythia, In principle, the digital quality of the images should be independent of the orientation and style of the physical apparatus that holds the breasts. (I’d be interested in a radiologist’s view on this.)