False Positive Versus Missed Positive

There has been much controversy about the anxiety that mammography, and especially additional imaging such as breast ultrasound and MRI, cause women. One reason analysts give to explain why women don't continue yearly mammograms is their fear of getting a false positive, a result that indicates the possibility of disease that may require additional testing and biopsy for a confirmed diagnosis. But a new survey shows nine out of ten women who had biopsies for positives that were determined to be false, say they would still opt for the additional screening the following year. The study was sponsored by Are You Dense, a great organization working to get legislation passed requiring physicians to tell women when they have dense breast tissue. Mammograms are often inconclusive on women with dense tissue and require further testing. Digital Mammography is still the best screening technology for detecting breast cancer. But in women with dense breast tissue the mammogram can sometimes only detect the cancer 40-50% of the time. Masses can be hidden on mammograms but observed on other screening modalities such as Ultrasound, Molecular Imaging and MRI. In some women with dense tissue additional imaging is often absolutely necessary.

Many of my patients in Ridgewood, New Jersey and the surrounding tri-state area are high risk women who have their annual mammograms and obtain additional imaging rather than take the chance of missing a cancer. We assess a patient’s family history and breast density while the patient is here and give all patients the results of their mammograms before they leave our office, so they know what is needed. If the breast tissue is extremely dense we will offer breast ultrasound at the time of the mammogram. If the tissue is only moderately dense or there is a strong family history of cancer we often suggest an interval breast ultrasound in six months so that the patient doesn’t go a full year without imaging. Molecular Imaging (Breast Specific Gamma Imaging) is also performed in our office but requires some advance notice. We refer our patients elsewhere for MRI. Would you opt for additional testing vs. the chance of missed cancer? Most of our patients say yes. What do you think?

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