Different Facts, Different Opinions

Hello bOObs Bloggettes:

Today we’ll start to tease apart why women are getting incorrect information on different aspects of breast cancer screening. One of the problems is that three different medical factions are working off of three different sets of information.

Let’s look at this example to set up the problem: A woman has dense breasts but is not told by her gynecologist (the referring physician who wrote the mammogram prescription) that her breasts are so dense that the radiologist has recommended — after looking at her mammogram films — that she should go for a followup ultrasound to rule out any possibility of cancer. Why does this gynecologist not tell her what the radiologist recommends? Who knows?!  But it may very well be because the association she/he belongs to (American College of Obstetricians and Gynecologists, or ACOG) says this in its advice about dense breasts:

“[ACOG] does not recommend routine use of alternative or adjunctive tests [e.g., ultrasound] to screening mammography in women with dense breasts who are asymptomatic and have no additional risk factors.” 

Hmmm. Now why would ACOG, who portends to be an “organization dedicated to the improvement of women’s health,” go against the recommendation of the radiologist who arguably knows a heckuva lot more about mammograms than an OBGYN? My guess is that it goes back to insurance (always follow the money). If every woman with dense breasts — remember that 90% of us have some degree of density — is given a follow up ultrasound to her mammogram, that’s gonna cost the insurance industry a lot of moolah!  I’ll go more into what ACOG tells its members in an upcoming blog, but suffice to say this is one messed up scenario.

The gynecologist is also one of the doctors who tells us that the amount of radiation in a mammogram is “low-dose” and is the same amount we get from “flying over the U.S.” — which is baloney (see a previous blog).

Speaking of radiation amounts, we also have different information being referenced by the radiologist vs. the radiation physicist regarding a mammogram’s radiation amount. Understand that a radiologist is a medical doctor that has studied how to conduct diagnostic tests such as mammograms and has been trained to read the results, such as mammography X-rays. However, what I’ve come to discover is that they aren’t experts on radiation (even though their titles would imply this). That actually falls on the radiation physicists, the folks with PhDs in such an area. These nerds understand radiation, and radiation amounts, and what those amounts mean for patients — but this information rarely gets to the doctor unless the doctor asks the physicists for their help. (Radiology groups and hospitals generally have a physicist at the ready to call when needed.)

Also understand that radiologists have their own associations that are also filling their heads up with incorrect information and soundbites to spread to other doctors and patients, such as mammograms are “low-dose” — yet the radiation physicist knows exactly how much radiation there is, knows it isn’t the same as flying across the U.S., and knows that the amount being absorbed directly into the breast can cause breast cancer years later.

So the accurate information on a mammogram’s radiation amount is being squirreled away by the physicists. Do the physicists know that the radiologists and gynecologists aren’t being forthcoming with the facts on radiation amounts prior to a patient’s screening simply because they don’t have the correct information? Who knows?!  But this affects a patient’s Informed Consent in that we aren’t being given reliable information by our doctors.

It’s kind of like “Dumb and Dumber” meets “Who’s on First?”

A quick personal story: I went into a hospital thinking that I was having a heart attack (long story, false alarm), and stayed overnight for observation. The hospital came up with the brilliant idea that I should have a stress test with radio-nucleotides the next day. I voiced that I was leery of radiation, and the radiologist assured me it was “low-dose radiation.” I finally relented. Later on, I discovered that it was really high-dose radiation, up there with an abdominal CT scan and, further, that I could have simply had an echocardiogram containing no radiation.

Fast forward a year later: The dentist said my teeth had suddenly gone south and required expensive (ouch) deep-scale (ouch, ouch) cleaning. “Did you by any chance have radiation this past year?” he asked me. Well, yes I had! I told him. He explained that the radiation apparently had leached the minerals out of my teeth leaving them vulnerable to an onslaught of bacteria.

Did the radiologist really not know that there was a non-radiative (and less expensive) test I could have taken? Who knows?!  But this was a comedy of errors for which I, the patient, paid the price — literally.

I’ll leave you with this thought: In the words of Martin Luther King, Jr., “There comes a time when silence becomes betrayal.”

Blog at you soon, thanks for reading and helping to spread the word! (Please see the “share” links and comments section below).

Stay healthy,

Megan

Megan Smith, M.S.
Director, bOObs: The War on Women’s Breasts

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