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Mammogram Guidelines Vary By State? What?

February 20, 2012
Written by: , Filed in: Breast Imaging, Diagnostic Imaging, Practice Management
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An Arizona woman received two contradictory reports about the same mammogram—first that she needed additional tests, then that she didn’t. As an explanation, she said, she was told that New York and Arizona had different guidelines about mammogram interpretation.

She got additional tests anyway. She discovered she had cancer in both breasts. She’s now receiving treatment.

The case became public when the woman, Sue Raney, contacted Gary Harper, the “3 On Your Side” investigative reporter for KTVK, known as 3TV, an independent television station in Phoenix, Arizona.

According to the original 3 On Your Side story, Raney received her annual mammogram in October. When she received an initial report of the results, she was told she needed more testing. Then, she said, “On November 7, I received another update on the same mammogram saying that everything was fine” and that there was “no evidence of cancer.”

She called the clinic where the mammogram was performed, AZ-Tech Radiology, which has seven locations in the Phoenix area. When she asked about the conflicting interpretations, she said:

I was told over the phone that the radiologist is from New York and he was using New York guidelines. Under New York guidelines I needed additional testing; under Arizona guidelines I did not.

Of course that’s not correct. Matthew Hum, an attorney for AZ-Tech, told Harper that perhaps there was a misunderstanding. He also addressed the difficulty of a situation in which two reads of the same mammogram differ:

You don’t want to expose a patient to too much radiation that would be too harmful. But then you don’t want to call them back for a diagnosis and then put them through an emotional roller coaster when it isn’t necessary. It’s hard to get it right every time.

A follow-up story quoted Hum as saying that as a result of the Raney case, AZ-Tech had revised its policy. Now, he said, if two reads of the same mammogram conflict regarding a need for further testing, the clinic will always recommend the testing.

Harper seems to have done a conscientious reporting job. He contacted Leslie Welk, MD, of The Laura Dreier Breast Center at Banner Good Samaritan Medical Center in Phoenix. Dr. Welk debunked the notion of differing state guidelines but also said:

“If you had a double read and one person called it negative and the other person said, ‘No, I think we should bring her back and look some more,’ that’s not particularly surprising, and that doesn’t necessarily speak to the quality of either reader.”

It’s hard to find any real villains in this case. But there is a hero: Raney, who did exactly what everyone should do. She took charge of her own health care and got another opinion when she thought she needed one.

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