More “Missed” Cancers

In the last blog we discussed cancers that are missed by breast imaging, and the emotional impact on the patient of a cancer. We tend to look at the impact on the physician as "merely" the risk of malpractice, but the facts go much deeper. Physicians, and particularly breast physicians, are emotionally affected by a missed cancer as well. Even though a "miss" may be explainable, every breast physician has a personal commitment to detecting cancers as early as possible.

Breast imagers measure their performance through the mammography audit. In the mammography audit the imager's recall rate, cancer detection rate, tumor size at discovery and other statistics are measured and compared with benchmarks. An important part of the mammography audit is also the reconciliation of all patients with findings other than a normal finding, other than those who are placed on a short interval follow-up. These patients (BIRADS 0,4,5) should be followed through biopsy and, preferably through surgery and the surgical pathology report to correlate the imaging findings.

Another important part of the mammography audit is a thorough review of all missed cancers (false negatives). Centers of excellence will typically subject the imaging studies involved to review by one or more independent breast imagers to determine whether the false negative was a "simple" miss, or a very difficult case that others would be expected to miss as well. This review process helps to ensure that correctable situations receive the attention they deserve.

Not everything about a missed cancer is bad. True breast imagers are among the most dedicated of physicians. Even the "misses" that cannot be avoided because they were not visible on imaging create a rededication of effort on the part of these physicians. The reality that we cannot find all breast cancers through imaging typically creates a level of humility in breast imagers that helps them to empathize with their patients. We see this as a passion for care that is unusual in medicine these days, but welcome to the women who are anxious about their breast health. This level of care is not universal, but it is available at centers of excellence in many towns and cities across the nation. Demand it!