ethics
01-24-2005, 10:38 PM
The primary weapon in the war against Cancer has been early detection. The faster cancer is detected the higher the chance of the patient's survival. Breast Cancer is no exception and the Mammography has been instrumental in saving lives. Or has it been?
Despite Congress passing new laws (Mammography Quality Standards Act -- MQSA) that would make Mammograms safer, more accurate, and useful, the medical technology has been plagued by <a href="http://my.webmd.com/content/Article/18/1689_51896.htm?printing=true">controversies</a>.
Many medical professionals are still maintaining that, at present, mammograms are the most effective tool we have to detect breast cancer. While this is true, there are many problems in how<a href="http://newyorker.com/printable/?fact/041213fa_fact"> Doctors scan mammographies</a>, not just with the imaging technology:
<font color="blue"><blockquote>Joann Elmore, a physician and epidemiologist at the University of Washington Harborview Medical Center, once asked ten board-certified radiologists to look at a hundred and fifty mammograms—of which twenty-seven had come from women who developed breast cancer, and a hundred and twenty-three from women who were known to have been healthy. One radiologist caught eighty-five per cent of the cancers the first time around. Another caught only thirty-seven per cent. One looked at the same X-rays and saw suspicious masses in seventy-eight per cent of the cases. Another doctor saw “focal asymmetric density” in half of the cancer cases; yet another saw no “focal asymmetric density” at all. There was one particularly perplexing mammogram that three radiologists thought was normal, two thought was abnormal but probably benign, four couldn’t make up their minds about, and one was convinced was cancer. (The patient was fine.) Some of these differences are a matter of skill, and there is good evidence that with more rigorous training and experience radiologists can become better at reading breast X-rays. But so much of what can be seen on an X-ray falls into a gray area that interpreting a mammogram is also, in part, a matter of temperament. Some radiologists see something ambiguous and are comfortable calling it normal. Others see something ambiguous and get suspicious.</blockquote></font>
Currently, the failure rate <a href="http://www.rednova.com/news/display/?id=110371">is from 15 - 20%</a> in detecting cancer using mammograms. False positives are also causing <a href="http://www.naplesnews.com/npdn/neapolitan/article/0,2071,NPDN_14939_3442379,00.html">long-term psychological and economic consequences</a>.
<font color="blue"><blockquote>The assumption has been that as long as a person eventually finds out the first test was wrong, any distress is transitory and minor — and that the cost of additional testing is worthwhile for the peace of mind it brings.
Instead, several new studies reveal that the impact of false positives can be serious and persist far longer than expected. One recent study showed that significant numbers of men who had a false positive on a prostate-cancer screening test still experienced anxiety several weeks after learning they were cancer-free.
And the medical costs of unnecessary additional testing can be considerable. In a study published this month, researchers found that men and women who had false-positive screening results averaged more than $1,000 each in follow-up care in the year following the test. </blockquote></font>
What other medical technology do we rely more on the image and reputation than the reality?
Despite Congress passing new laws (Mammography Quality Standards Act -- MQSA) that would make Mammograms safer, more accurate, and useful, the medical technology has been plagued by <a href="http://my.webmd.com/content/Article/18/1689_51896.htm?printing=true">controversies</a>.
Many medical professionals are still maintaining that, at present, mammograms are the most effective tool we have to detect breast cancer. While this is true, there are many problems in how<a href="http://newyorker.com/printable/?fact/041213fa_fact"> Doctors scan mammographies</a>, not just with the imaging technology:
<font color="blue"><blockquote>Joann Elmore, a physician and epidemiologist at the University of Washington Harborview Medical Center, once asked ten board-certified radiologists to look at a hundred and fifty mammograms—of which twenty-seven had come from women who developed breast cancer, and a hundred and twenty-three from women who were known to have been healthy. One radiologist caught eighty-five per cent of the cancers the first time around. Another caught only thirty-seven per cent. One looked at the same X-rays and saw suspicious masses in seventy-eight per cent of the cases. Another doctor saw “focal asymmetric density” in half of the cancer cases; yet another saw no “focal asymmetric density” at all. There was one particularly perplexing mammogram that three radiologists thought was normal, two thought was abnormal but probably benign, four couldn’t make up their minds about, and one was convinced was cancer. (The patient was fine.) Some of these differences are a matter of skill, and there is good evidence that with more rigorous training and experience radiologists can become better at reading breast X-rays. But so much of what can be seen on an X-ray falls into a gray area that interpreting a mammogram is also, in part, a matter of temperament. Some radiologists see something ambiguous and are comfortable calling it normal. Others see something ambiguous and get suspicious.</blockquote></font>
Currently, the failure rate <a href="http://www.rednova.com/news/display/?id=110371">is from 15 - 20%</a> in detecting cancer using mammograms. False positives are also causing <a href="http://www.naplesnews.com/npdn/neapolitan/article/0,2071,NPDN_14939_3442379,00.html">long-term psychological and economic consequences</a>.
<font color="blue"><blockquote>The assumption has been that as long as a person eventually finds out the first test was wrong, any distress is transitory and minor — and that the cost of additional testing is worthwhile for the peace of mind it brings.
Instead, several new studies reveal that the impact of false positives can be serious and persist far longer than expected. One recent study showed that significant numbers of men who had a false positive on a prostate-cancer screening test still experienced anxiety several weeks after learning they were cancer-free.
And the medical costs of unnecessary additional testing can be considerable. In a study published this month, researchers found that men and women who had false-positive screening results averaged more than $1,000 each in follow-up care in the year following the test. </blockquote></font>
What other medical technology do we rely more on the image and reputation than the reality?