False-Positive Mammograms: Balancing Patient Fear with Patient Care

Recently, the Los Angeles Times published an article entitled “False-positive mammograms take mental toll, study finds.”

As a radiologist in Los Angeles. I am , of course concerned  with and sympathetic to the anxiety created when an abnormality is detected on a screening mammogram.

I believe there are several important issues not addressed in the above article.  An abnormal finding on screening mammography initiates a workup, which frequently involves additional mammographic images, or additional interrogation with modalities such as ultrasound or MRI.  Frequently, it is expected that the abnormal finding, on further interrogation, turns out to be a nonmalignant entity.  Benign cysts,  benign neoplasms, infection or inflammatory etiologies can produce abnormalities on mammograms as well.  Frequently, a “spot”” on mammography turns out to be simply an anatomic variant, asymmetry related to the fact that we are  all different internally.These ” false positives” need to be explained, we need to exclude that they are caused by a cancer.

In the same way that a dermatologist looks over, or screens a patient’s skin surface, identifies an abnormality and determines the appropriate course of action, including biopsy, mammography screens breast tissue.  It would be irresponsible of a dermatologist to not look over the patient’s skin for fear of making a finding which could alarm a patient. It is an important first step in a medical workup.

Furthermore, the article does not address the mental cost, of not looking, i.e.  how well would  a women sleep, knowing that they simply hadn’t looked for a possibly identifiable illness. Surely this would  create its own level of anxiety.

Interested in hearing your thoughts.

-Glenn Wedeen, M.D., Radiologist at ONRAD, Inc.

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