Medical malpractice concerns lead to more breast biopsies

06/27/05

OAK BROOK, Ill.-- Some women may be undergoing unnecessary diagnostic imaging and breast biopsies because radiologists are worried about medical malpractice suits, according to a study in the July issue of Radiology.

"Radiologists who interpret mammograms in the United States have higher recall and false-positive rates, possibly due to heightened concern about medical malpractice," said the study's lead author, Joann G. Elmore, M.D., M.P.H., associate professor of medicine at the University of Washington School of Medicine, and section head of the Division of General Internal Medicine at Harborview Medical Center in Seattle. "Women are extremely anxious about breast cancer. More testing leads to more anxiety among women."

Dr. Elmore and colleagues surveyed 124 radiologists who regularly interpret mammograms in Washington, Colorado and New Hampshire. A majority (76.4 percent) of respondents expressed concern over the impact that medical malpractice has had on mammography practice. More than half (58.5 percent) indicated that this concern moderately to greatly increased their number of recommendations for breast biopsies, and 72.4 percent reported their concern moderately or greatly increased their number of recommendations for diagnostic mammography or ultrasound.

The recommendation rates for additional testing after a screening mammogram are much higher in the United States than in other countries. However, Dr. Elmore said previous studies have shown that a higher recall rate does not necessarily result in higher cancer detection rates.

"The majority of women who are called back for additional testing after a screening mammogram do not have any evidence of breast cancer on subsequent evaluation," she said.

Failure or delay in breast cancer diagnosis is one of the most prevalent and expensive conditions in malpractice claims lodged against physicians. Many of the claims occur because of misinterpretation of the mammogram or delay in reporting abnormalities. Approximately half (52.4 percent) of the radiologists surveyed for Dr. Elmore's study reported at least one prior malpractice claim.

A related study published in the May issue of Radiology found that one-third of radiologists considered withdrawing from interpreting mammograms because of malpractice concerns.

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