Bringing Mammography into Focus

Conflicting information in the media often leads to patient confusion.


Do you remember the Magic Eye stereograms you may have had as a kid? At first, the image is a confusing, distorted mess of pixels. As you stare at the page, your eye cannot rest on one thing; it's just endless rows of patterns. But after a moment, your eyes focus, and the distorted pixels sort themselves into a 3-D image. Everything makes sense.

For some patients, understanding mammography may feel like a first look at a stereogram. With headlines on research such as the Canadian National Breast Screening Study and comments from Swiss Medical Board members expressing concerns about mammography, patients often receive conflicting information. Many aren't sure about the process, when they should get screening, and if they need a mammogram at all.

With so much confusion around the topic, how do you address your patients' concerns about mammography? Carol H. Lee, MD, FACR, head of the ACR Committee on Breast Imaging Communication, simply has a conversation with concerned patients, sticking to the facts about the value of screening. The recent update of the Canadian breast screening study that showed no benefit from screening received a great deal of media attention, but it needs to be put into context, Lee says. This study is an outlier among several other randomized trials, all of which show a benefit from screening mammography. Lee also reminds her patients we now have real-life experience with screening that shows that since widespread mammography screening was introduced, mortality from breast cancer has declined 30 percent in the United States. Relying on studies done 30 years ago, Lee says, is like looking at last week's weather forecast to tell you if it's raining outside.

And in order to provide the best information to patients, breast imagers must ensure that they are aware of all the facts and figures about mammography. "Everyone — patients, other clinicians, and even radiologists — can get confused about this data," says Lee. "So you have to present your evidence to the patient and let them make an informed decision. It's important that you have an open dialogue, rather than simply dictate what a patient should or shouldn't do."

One way to encourage an open dialogue is to start it yourself, says Debra L. Monticciolo, MD, FACR, head of the ACR Committee on Breast Imaging Education. She verbally reminds her patients to come in every year for a screening. She also tries to take every opportunity to address patients' concerns. "When I'm giving results or when I'm acquiring a consent form, I always pause to ask if the patient has any questions or concerns. I find that my patients really appreciate that opening, even if they do not have any pressing issues." Lee agrees. "We're all busy," she says, "but it helps radiology in general when we present ourselves as physicians who patients can relate to rather than just names on a report."

Your staff can also be a big help in opening communication, especially as they are frequently interacting face to face with your patients. "I've had patients tell my technologists that they weren't sure they should get screened every year," says Monticciolo. "My technologists will go ahead and remind them how important it is. I make sure my staff is as informed about current mammography data as I am."

Another thing Lee says to make sure you think about is the way you speak with patients. You have to make sure what you're saying is understandable without being condescending. And show empathy. "When I do procedures like mammograms or breast biopsies, it's an everyday procedure for me. But for my patients, it's a new and frightening experience," she says. Patients will have concerns and be afraid. It's important to reach out to them and understand they may have a whole slew of questions for you, despite the time it might take to answer them.

" We're all busy, but it helps radiology in general when we present ourselves as physicians who patients can relate to rather than just names on a report."
— Carol H. Lee, MD, FACR

Ultimately, both Lee and Monticciolo agree that these tips could be used across the spectrum of modalities and that every radiologist should brush up on communication. "Open communication creates an informed patient," says Lee. "And an informed patient can make good decisions and take charge of her health care."

By Meghan Edwards, ACR Bulletin copywriter


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