Mammograms are changing, but the change is not as beneficial as it should be

Compression Obsession

Mammography technology has entered the digital age.

Unfortunately, mammography technology managed to enter the digital age by taking a big step backward.

Don’t train on me

A recent New York Times article focused on a typical problem for doctors who make the transition from mammography that produces images on film to mammography that produces digital images.

As you might expect, the new images are much clearer, which helps doctors spot problems. But a thorough reading of a mammogram image requires comparison to a patient’s previous mammograms. So when a doctor compares a sharp digital image to a fuzzy film image, he may spot irregularities that are actually just differences in the images rather than a change in the breast.

Meanwhile, during this transition, it’s common for women to be called back for follow up mammograms that turn out to be unnecessary. And in some cases, unnecessary ultrasound exams and even biopsies have been ordered.

Obviously this causes women considerable undue anxiety, as well as the extra expense of a follow up digital mammogram, which is already costing them more than a film mammogram.

One radiologist told the Times that he just explains to a patient that she is a “victim of technology.” He says: “Your last one was film; this one was digital. They look different, and we just didn’t know that.”

Ah. You just didn’t know that. Then why didn’t you get some TRAINING before you scared the daylights out of me?

Doesn’t it seem like there’s a link missing here? Why are these doctors getting trained on the job? Shouldn’t they attend a seminar to get an idea of the different things they’ll be seeing in digital images that they wouldn’t see on film?

Imagine going to a dentist who says, “I’m not quite used to this new drill yet, so bear with me while I get the hang of it.” I don’t think so! When you get the hang of it, call me and I’ll make another appointment.

Same old same old

Okay, so now we know: There’s a period of transition and we shouldn’t be shocked when a radiologist runs up our bill and scares us half to death while he gets accustomed to the digital age.

Meanwhile, the REAL problem here is that this new technology is mostly about the image, not the technique. In other words, we women are still exposed to high levels of radiation (although slightly less than with a film mammogram), and our breasts are still uncomfortably compressed between two plates (although the compression time is slightly reduced).

The problem here, as I’ve noted in previous e-Alerts, is the “compression contradiction.” Medical students are taught to examine breasts gently in order to keep possible cancer from spreading. Then those same gently examined breasts are painfully flattened and x- rayed.

In those e-Alerts in which I’ve addressed this problem I’ve also told you about alternative breast-imaging techniques that don’t use radiation and offer the huge advantage of no compression. So there’s less pain and less chance of prompting cancer spread. And while I had high hopes that the mainstream was starting to move toward these alternative techniques, now we find out that radiologists are making the transition to an improved image, but still dragging along a ridiculously outdated technology.

And because they’re upgrading to digital mammography, spending hundreds of thousands of dollars on new equipment, they’ll be even less inclined to entertain the concept of using techniques that require no radiation or compression.

Their step up in technology is a step back for women.

You can find more information about mammogram risks and safe alternatives to conventional mammography in the e-Alert “End of the Day” (2/22/07).

“In Shift to Digital, More Repeat Mammograms” Denise Grady, The New York Times, 4/10/08,