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VOL. 24. NO.1 AUGUST 12, 2003

Who will read mammograms?

BY LAWRENCE BASSETT

There’s a shortage of radiologists who read mammograms and interpret other breast imaging diagnostic tests, and the situation likely will get worse before it gets better. Unfortunately, the shortage comes at a time when more and more women are getting mammograms.

My colleagues and I surveyed third- and fourth-year radiology residents who had completed breast-imaging rotations at 211 accredited radiology residencies in the United States and Canada. While 64% of residents said they would not consider a fellowship in breast imaging if offered, 63% said they would not want to spend one-fourth or more of their time in clinical practice on the interpretation of mammograms, according to the study, which appeared in the June issue of Radiology.

As our population grows and women continue to increase their use of screening mammography, we anticipate a great need for qualified radiologists to supervise and interpret mammograms. Training sufficient numbers of residents to perform this vital task in the future is an important challenge for radiology residency training programs across the nation.

The most common reasons residents didn’t want to go into mammography included fear of lawsuits, too much stress and low reimbursement levels. They also characterized this area of expertise as not interesting enough.

The study found that 87% of residents rated interpretation of mammograms as more stressful than other types of imaging, a number much higher than we would have thought. The finding that surprised us the most, however, was the concern about medical malpractice liability. It appears residents are very attuned to medical-legal issues.

Adding to the dilemma is an increasing number of higher-tech specialties such as neuroradiology, which involve complicated procedures where radiologists get to use CT, MR and interventional angiography. These specialties, which are also short-staffed, often are viewed as more attractive and take away residents from mammography. Traditional breast imaging relies heavily on conventional radiography, although there are interventional procedures and an increasing use of digital technology and sophisticated high-resolution ultrasound equipment.

Still, the outlook for access to quality breast imaging is dismal.

Because of the Baby Boomer population, an additional 1 million women annually enter the pool of those needing screening mammograms. In addition, because breast cancer is more common in older women, we are seeing a rising number of breast cancers as the older population increases. The National Center for Health Statistics recently reported that the female population, ages 40 to 84, will increase from 64.6 million to 77.4 million within the next two decades.

Meanwhile, clinics and hospitals are reluctant to expand their mammography departments. If they have to choose where to put their resources, most will opt to put money into the more lucrative services — those that pay their own way. Because mammography is a money loser, most clinics and hospitals don’t want to invest in it.

In addition, technical reimbursement for mammography services is lower for hospitals than it is for outpatient facilities, which has had a major impact on teaching institutions like UCLA.

It’s critical that we begin to address these issues immediately so that training programs can provide adequate numbers of skilled interpreting physicians in the future.

Bassett is director of the Iris Cantor Center for Breast Imaging at UCLA’s Jonsson Cancer Center.