Nursing: Mammography: Playing radiologist roulette

Radiologists may be missing far more breast cancer tumors than presumed, according to a yearlong New York Times investigation. By evaluating studies and interviewing hundreds of physicians and mammography regulators, researchers in New Hampshire and North Carolina found that radiologists' skills vary widely. In some clinics, they missed nearly 4 out of 10 tumors.

Federal mammography standards implemented in the early 1990s have triggered improvements in technology, but they haven't done enough to ensure competency among radiologists. Federal standards require a radiologist to read only 480 mammograms per year to maintain her skills, but many experts say she needs to interpret at least 2,500 films each year to keep her skills sharp.

Furthermore, an official method for tracking missed tumors doesn't exist, so most radiologists can't even determine the accuracy of their own work. In the nineties, regulators considered implementing measures of radiologists' competency, such as skills testing and tracking physicians' accuracy. But regulators never adopted the standards because physicians successfully argued that such data would be challenging to collect and interpret. Plus, the fear of having such data fall into plaintiff attorneys' hands could drive many radiologists away from mammography interpretation. But faced with new evidence that interpretation skills need improvement, regulators may take a second look at ways to improve this aspect of mammography.

Source: "Spotting Breast Cancer: Doctors Are Weak Link," The New York Times, M. Moss, June 27, 200