TUESDAY, June 28, 2005 (HealthDay News) -- Radiologists' concerns about medical malpractice may bias their decisions on whether to recommend repeat mammographies or biopsies, new research finds.
"We're the first to report this," said study author Dr. Joann G. Elmore, an associate professor of medicine at the University of Washington, in Seattle. Her report appears in the July issue of Radiology.
"There is a lot in the news about malpractice and litigation, but very little scientific data about how the malpractice climate could be influencing the practice of care in the United States," said Elmore, who has researched the differences in the rates of recall, or repeat, mammograms in the United States vs. other countries. "The recall rate in the U.S. is much higher than in other countries," she noted.
She and others had hypothesized that it is due to the malpractice climate here; this latest study suggests that hypothesis is accurate.
The analysis included input from 124 radiologists in three states -- Washington, Colorado and New Hampshire -- who had together interpreted a total of more than 557,000 screening mammograms. About half had reported a prior malpractice claim, and nearly 15 percent of those claims were related to a mammogram.
Not surprisingly, radiologists consider malpractice claims very stressful. Elmore's team found that 81 percent of the 63 radiologists who answered questions regarding the anxieties of a malpractice claim described it as "very" or "extremely" stressful.
In other findings, 72.4 percent believed their malpractice fears moderately or greatly increased the number of recommendations they made for mammography or ultrasound. More than half (nearly 59 percent) said concerns about medical malpractice also moderately or greatly increased the number of recommendations they made for breast biopsy.
Another expert familiar with the results said he was not surprised by the findings. "If anything, they are understating the concern," said Dr. Leonard Berlin, chairman of the department of radiology at Rush North Shore Medical Center, in Skokie, Ill.
The trend, said Berlin, is for doctors today to be sued not for acts of commission, but for acts of omission, such as not detecting breast cancer in its early stages.
Radiologists are understandably concerned they may be sued if they see something slightly abnormal on a mammogram and don't order either a repeat test, an ultrasound or a biopsy for fear the abnormality is -- or will develop into -- cancer, Berlin said.
The message for consumers, agreed Berlin and Elmore, is that understanding the reasoning behind some of these recalls may make the process less anxiety-producing. When recalled, women should try not to be alarmed.
Patients should also realize that "most of the time the recall is going to turn out to be nothing," according to Berlin. Radiologists now "have to practice defensively," he said.
Berlin said that he, too, errs on the side of repeating tests or doing additional tests if there is any question. "If I have the slightest doubt [about whether a patient has breast cancer] I am likely to order a biopsy," he said.
"Women should realize that a screening mammogram is just that," Elmore said. "We have a different threshold for our alarms [to order repeat or additional testing] compared to other countries." she said.
Patients who want to reduce the odds of getting called back for repeat or additional testing should be sure to go to the same facility each year, she said. That increases the chance your mammogram will be done on the same machine and read by the same person. The facility can also easily compare this year's result with previous ones.
Younger women who are still menstruating ideally should not get a mammogram right before their period starts, Elmore said, because their breasts may be swollen and tender, increasing the discomfort.
And women can realize that the "squishing" of the breasts, which can be uncomfortable, is a good thing, medically speaking, Elmore added. "It both reduces the amount of radiation and improves the image quality," she said.
With time, however, the odds of getting called back for a repeat test will increase, Elmore said, and it may help to understand that that's perfectly normal. "After 10 mammograms, you have a 50 percent chance of having at least one recall, and a 20 percent chance of having a biopsy," she said, citing her own research on the topic.
More information:
For more information on mammograms, visit the National Cancer Institute.
