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CR Mammography Stirs Tempest In Canada

May 16, 2013
Written by: , Filed in: Breast Imaging, Medical Ethics, Practice Management
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study published online in Radiology on Tuesday has sparked an uproar in Canada over whether to continue using computed radiography mammography scanners.

The study of 816,000 mammograms compared the performance of CR, digital direct radiography, and X-ray film. The mammograms, carried out on 688,000 women ages 50 through 74, were done in 2008 and 2009 in the Canadian province of Ontario.

The cancer detection rates were similar for DR (4.9 cancers per 1,000 mammograms) and film (4.8), but significantly lower for CR (3.4).

That led Ontario Health Minister Deb Matthews, PhD, to order that CR machines in the province be scrapped. She told the Globe and Mail of Toronto:

We are moving very quickly to replace the mammogram technology that isn’t providing as high a quality as it could be.

Of Ontario’s 316 mammography machines, 76 use CR technology, 188 use DR, and 52 use film. The Ontario Association of Radiologists had recommended in 2010 the phasing out of CR machines in favor of DR technology. “In most of the provinces, it has been recommended for a number of years,” said association President Mark Prieditis, MD.

Canada’s other provinces use only a handful of CR machines—except for Quebec, where CR devices constitute 108 of 144 total mammography scanners. And Quebec plans to keep using them, even though mammography patients have been barraging their physicians’ offices with questions and concerns.

In a prepared statement in French, Réjean Hébert, MD, the Quebec health minister, said:

There is no evidence at this time that mammography equipment used in Quebec offers lower performance.

Hébert said the province was taking the study seriously and would consult experts to determine how to proceed.

One set of experts defended the decision to continue using CR machines. The president of the Association des Radiologistes du QuébecAndré Constantin, MD, said replacing the equipment and encouraging women to be retested would be “overreacting” and “excessive.”

He said the province would examine detection rates for its machines and use that data to plan the best course of action.

Related seminar: Chicago International Breast Course and The Society for the Advancement of Women’s Imaging

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