False-positives for breast cancer: They're more common than you think
False-positives for breast cancer: They're more common than you think
Your role is to manage patients' expectations
Once again, the national media has focused attention on another potential controversy in the area of breast cancer - and once again, breast centers need to respond to the public's concerns.
A study reported in the April 16 issue of The New England Journal of Medicine found that over a 10-year period, about one-third of the women who had annual mammograms experienced a false-positive result. In the false-positive tests mammograms showed an abnormal result, but upon further testing, no breast cancer was found. The authors of the study say false-positive results cause undue anxiety in women and lead to higher health care costs because of the extra screening required.
But is this really an issue? Health professionals in the breast cancer field say it isn't and claim mammography is still the best screening method for breast cancer detection in terms of cost and effectiveness. Even with new advanced technologies in breast cancer screening being tested nationally - such as computer-aided mammography, MRIs, and ultrasound - there is currently no substitution for an annual mammograms.
"A false-positive test is a negative way of describing a benign finding," says breast surgeon Katherine Alley, MD, medical director at the Betty Ford Comprehensive Breast Center at Columbia Hospital in Washington, DC. "Of the breast patients I've seen over a number of years, I've only had one or two who felt they suffered stress from having an additional X-ray or additional breast exam and then finding out it was a benign biopsy. Statistically, the percentage of women in the study requiring surgery for further examination was only about 5%."
Medical experts don't know what causes breast cancer, and the best way of combating the disease is through early diagnosis using self-exam, clinical breast exam, and mammography, Alley says. "In fact, mammograms are the only way of detecting microscopic breast cancer," she says. "An MRI doesn't pick up microscopic cancer."
The use of advanced screening technologies are only for a selected number of patients, Alley says.
"However, there are things health care professionals can do to help ease patients' concerns when they receive a positive reading," she says. "Many women are sent home and not told about the initial findings while they are at the health care facility, so they don't have immediate feedback about their test. Then, when they're called back for further examination, there's no one who talks to them."
Alley recommends that physicians take time to explain to patients about the likelihood of a benign finding.
Education helps allay fears
Judith Macon, RN, breast center program manager at Suburban Hospital in Bethesda, MD, is expanding comprehensive breast services for the community because of what she perceives as a tremendous need to educate women on breast health so they can combat their fears and battle misinformation in the media.
"There's always a need for education about breast cancer," says Macon, who adds that her presentations are always well-attended.
"Women want to know any new findings, and more importantly, what they can do to balance the scale in their favor because breast cancer is still a frightening diagnosis," she says.
It's a scary disease because women don't feel they have a lot of control since the cause is unknown, Macon says. "And although all kinds of cancer are scary, breast cancer is also visible [when compared with an internal organ] and connotes a woman's sexuality and femininity, so there's more sensitivity about the disease," Macon explains.
The best way women can "balance the scale," Macon says, is by early detection through self-exam, clinical breast exam, and an annual mammogram.
Eight of 10 lumps benign
In light of the recent news about false-positive mammograms, Macon says health care professionals need to educate women more about benign breast disease.
"For example, women need to know that eight of 10 breast lumps are not cancer," she says. "You can't ignore the lump, but you don't have to freak out."
In educating women and responding to the media, health care professionals should also emphasize "the real story" of how many lives are saved when breast cancer is detected by mammogram, Macon says.
"Mammography is not a perfect technology, but it's the best one we have right now and shouldn't be pushed to the side," she says. "Radiologists don't make a diagnosis; they report what they see. And physicians are obligated to follow up on any abnormalities, even if it ends up being a false-positive."
Providers don't want to cause undue stress and worry, but they want to be thorough, Macon says. "In most cases, it's [a matter of] taking another picture to see if anything has changed. But physicians should be sensitive to not let women wait too long for the second test."
Patients should also consider that although an MRI is good diagnostic tool, it costs thousands of dollars, says Macon. What's more, neither MRIs nor ultrasound can pick up fine calcium deposits like mammograms can.
Macon says that during her presentations, audience members ask a lot of questions, such as: My doctor told me I have cystic breasts, what does that mean? She also shows slides of surgical procedures so women can see what a reconstructed breast looks like.
In addition, she addresses women's fears about performing self-exam. "Many are scared because their breasts feel lumpy and they don't know what to look for. Women need to become aware of their breasts. The trick is to do it in a consistent and timely manner, so you can find something earlier and not ignore it."
Also helpful in presentations is bringing photographs of breast cancer visual aids, such as a breast vest (a rubber model of breasts which strap onto your body), which allow women to experience what a lump feels like. Macon also distributes literature from the National Cancer Institute in Bethesda, MD, the American Cancer Society in Atlanta, and the National Alliance of Breast Cancer Organizations in New York City.
"Everything you read is scary. I try to present a more balanced picture in interpreting the statistics, a more realistic view of risk factors," says Macon. "For example, the statistic that one in nine women will get breast cancer is not a lifetime risk. With an 85-year-old woman, it's one in nine, but the risk is lower in 50-year-old women, and even lower among 25-year-olds."
Macon also initiated a World Wide Web site (http://www.suburbanhospital.org) to update the community on breast cancer news. The Web site includes the hospital's newsletter.
"Women need to be educated consumers, and we're dedicated to helping women in the community take charge of their health," says Macon.
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