But physician shortages, rising costs and increased potential for error make same-day follow-up increasingly uncommon, say UC Davis researchers
(Sacramento, CA) -- Women who have been told they have an abnormal screening mammogram experience much less stress when they receive further testing that day compared to women who are asked to come back later for a diagnostic work-up, say UC Davis radiologists. Their study is published in the January issue of Radiology.
Nevertheless, this option has become increasingly unfeasible, the researchers say. "Offering same-day follow-up to women with abnormal results used to be common, but it has become rare because of rising costs, a nationwide shortage of mammographers and the increasing demand for mammography," said Karen Lindfors, a professor of radiology at the UC Davis School of Medicine and lead author of the study.
In addition, offering same-day evaluations -- known as on-line readings -- may increase the chances for error and prevents the mammographer from seeking a consensus view from a colleague, Lindfors said. "For the interpreting radiologist, finding the rare early breast cancer in screening mammograms requires intense concentration," Lindfors said. "The pressure of having a waiting patient can reduce the radiologist's ability to focus on the films."
The issue requires more study so that healthcare providers can balance the needs of patients with the delivery of high-quality, cost-effective health care, said Lindfors.
In the meantime, Lindfors recommends that healthcare providers educate their patients that fewer than one in 10 women with abnormal mammograms will be diagnosed with breast cancer.
According to the American College of Radiology, between 1987 and 1998, the percentage of women over age 40 who have undergone routine mammography has increased from 29 percent to 67 percent. Moreover, the number of radiology residents who have chosen to specialize in mammography dropped from five percent to one percent between 1995 and 1997 while the number of radiologists who have chosen to retire increased from a historical average of 400 per year to 600 in 1998.
"As the use of mammography screening for breast cancer increases, so does the number of women who must cope with abnormal results," Lindfors noted. "Our survey clearly shows that providing immediate diagnostic imaging can reduce the stress of a false positive mammogram. However, providing immediate results would significantly increase overall wait times for mammography appointments, which women already consider to be too long."
While mammography is a vital tool for detecting breast cancer early, the test is fallible. About 10 percent of screenings show irregularities that turn out to be benign -- a result known as a false positive. Women with abnornal screening mammograms are asked to undergo additional imaging or an ultrasound.
In a retrospective study, the UC Davis investigators analyzed anonymous questionnaires from 121 women who had needed further testing after their initial mammogram detected abnormalities. Of these, 50 surveys came from women who underwent an immediate work-up and 71 from those who had to wait. Women in the study ranged from 30 to 91 years of age, with an average age of 54. All were asked to rate the stress of their experience from the time they received the result of their mammographic exam until they received their follow-up results. Respondents used a scale of one ("not stressful at all") to 5 ("extremely stressful.")
Average overall stress for the group receiving immediate work-ups was 2.3; for group returning for subsequent evaluation, average stress was 2.79, a statistically significant difference, according to Lindfors. Both numbers are in the mild-to-moderate stress range. Women who were under age 50 and had a first-degree family history (mother, sister or daughter) of breast cancer experienced the most anxiety.
Jacqueline O'Connor, Ph.D. and Rebecca Parker, Ph.D. of the UC Davis School of Medicine and Medical Center also contributed to the study, which was funded in part by the Breast Cancer Fund of the state of California.
For a copy of Dr. Lindfors' study, call Laurie Slothower at 916-734-9023.
Copies of all news releases from UC Davis Health System are available on the web at http://news.