Dedicated breast surgeons, who are responsible for the treatment of breast cancers, performed as well as specialized breast radiologists when screening mammograms, stated a six-year study presented this week at the American Society of Breast Surgeons.
The prospective research involved 10,020 mammograms performed at a surgeon-run South African breast health center between January 2003 and June 2009. It found that the diagnostic accuracy of the breast surgical team was similar to that of specially trained, dedicated breast radiologists in national European and Australian screening programs. The surgeons’ accuracy was higher than that of typical U.S. radiologists reading mammograms, whose patients often have a greater number of repeat exams, more negative biopsies and a lower cancer detection rate.
“These findings suggest that the ability to precisely analyze breast images is enhanced by both ongoing experience and specialized training,” comments Justus Apffelstaedt, MD, FCS (SA), from the University of Stellenbosch and chief author of the study. He notes that the surgeons, as well as radiation technologists, had intensive training in mammography interpretation before starting to read mammograms and are participating in about 100 hours annually of continued professional development in clinical breast imaging.
According to Dr. Apffelstaedt, many countries, including the U.S., suffer from a shortage of radiologists specifically trained in and practicing mammography interpretation with the frequency required for maximum precision. “It is very well documented in the literature that physicians must read 2,000 mammograms each year, every year, to maintain peak performance,” he says.
“While in the U.S. mammograms are read by highly trained board-certified radiologists, about 2/3 of these physicians interpret breast images only occasionally and often see less than 500 mammograms a year. And the U.S. is not alone in this situation. In a number of other countries mammogram interpretation is handled by other medical professionals.”
Dr. Apffelstaedt believes the study suggests that shifting mammography reading from general radiologists to specially trained breast surgeons may be beneficial when dedicated breast radiologists are not available. In the U.S., breast surgery is a growing medical specialty. Many of these physicians have completed breast surgery fellowships or other focused training and have participated in the educational opportunities offered by organizations such as the American Society of Breast Surgeons. “Breast surgeons are highly trained and already involved in multiple aspects of breast health. Mammography reading may represent a useful extension of that role in certain circumstances in the future,” he says.
Today, Dr. Apffelstaedt advises patients with mammogram irregularities who are referred for biopsies to bring their images along with their reports to their surgical consults. “Breast surgeons are a highly qualified source for second opinions and for ongoing breast care,” he notes. “All women should take advantage of this.”