Mammography screening saves lives (does it?)

“Mammography Screening” is now a familiar concept, especially for women aged 40 and over living in big cities. Women who cannot get their annual mammography screening into their routine for various reasons must be aware that they are not fulfilling their “duty” regarding their health. So, how safe do those who have a yearly scan feel? As it turns out, completely… However, they are wrong!

The results of a 3-year study at the university revealed that mammography practices in Turkey are generally of poor quality.There is more than one reason for this poor quality, but contrary to what is generally believed, the main reason is not that the mammography devices in our country are old. On the contrary, all the devices in use are sufficiently new, technically sufficient and of high quality.

( 1) The main reason for the lack of quality is that these devices cannot be used efficiently and effectively. Among the reasons for this are the lack of education and information, effort to limit costs and indifference. Hospital administrators consider the condition of “being the cheapest” instead of “suitability for the device” in the purchase of consumables, citing the current tender laws. This situation is not unique to public hospitals; The general principle in universities, private hospitals and private laboratories is not to produce “quality” but “least costly” work. According to the state’s budget implementation instruction (BUT), the inspection fees are so far from meeting the real cost that the only solution for all institutions that have to work with the Social Security Institution seems to be to minimize the cost. One of the ways to do this is to take care of the most patients in the least amount of time. The findings of our study showed that the patient density in 26% of the mammography departments and environmental conditions such as light, noise and extreme temperature in 21% negatively affected the evaluation of the radiologists, but much higher rates can be expected if the tolerance and helplessness developed in adverse conditions are taken into account. findings, the tests that need to be done every day to ensure quality, mammography devices only 7%It shows that it is possible and this rate is even lower on the basis of private centers. in 20% Periodic (6-month and annual) service maintenance of mammography devices is not carried out because it is tried to save money from the maintenance agreements required for this. On the other hand, 70% of radiologists consider the quality of their self-rated mammograms as “very good or good” and 21% as “moderately good”. These findings mean: At least 70% of radiologists do not know how to evaluate image quality correctly.

Image quality is VITAL in mammography because the radiologist cannot report breast cancer that they cannot see! Aware of the risk, radiologists report many things they see as “suspicious” rather than “mistaking a possible cancer.” Thus, women who do not actually have anything important are directed to other unnecessary tests and biopsies. From the radiologist’s point of view, it is much easier to refer the patient to the surgeon for biopsy without taking the risk of “skipping the cancer”, than trying to improve the quality of the mammography.

( 2) Mammographic quality should not be thought of as “image quality”… Evaluation quality is just as important as image quality..!The factors that determine the quality of evaluation are ‘knowledge’ and ‘experience’, as well as extremely personal character traits such as meticulousness, curiosity, attention and care. Contrary to the common belief among physicians, unfortunately, mammographic examination is not the skill of the device; mammographic examination and evaluation is a medical art . There are elements that make a painter a ‘good painter’, a cook a ‘good cook’, a surgeon a ‘good surgeon’, and a radiologist a ‘good radiologist’. These elements are the knowledge and experience gained by ‘living, researching, experimenting, measuring, analyzing and developing’ rather than ‘reading’, which is related to the above-mentioned character traits. Becoming a radiologist requires at least 4 years of residency training after the Faculty of Medicine, which is no different than the time required to become a surgeon or internist. After this period, some radiologists may choose to specialize in one more subfield. Radiology also has sub-branches like cardiology, nephrology, endocrinology; such as breast radiology, neuroradiology, pediatric radiology and abdominal radiology. There are about 10 radiologists, all of them working at universities, who are breast radiologists by their own choices and extra efforts in Turkey, but the Ministry of Health does not officially endorse “breast radiology” as a sub-branch. This stands as an obstacle to the rapid training of breast radiologists for the country’s needs. In almost all private and public hospitals in our country, mammography evaluations are performed by ‘general radiologists’ who are not specialized in breast radiology.

( 3) Another factor affecting the quality of the evaluation is how the patient is referred to the radiologist. For those of you who have had mammograms, the usual story is told: A patient goes to a General Surgery or Obstetrician for a breast complaint or for annual breast cancer screening. The doctor listens to the patient, sometimes after performing a breast examination and sometimes without examining him, saying: ‘you go, get a mammogram and a breast ultrasound and come back’.

The patient’s perception develops as follows: one. This person will make the diagnosis! He is my only doctor. 2. He said, ‘A mammogram and a breast ultrasound’, so it doesn’t have a feature. Where would it be easier and cheaper to have it done?’ The patient, unaware of the nature of the examination, seeks an easy, inexpensive (if possible, no fee) center. He usually never meets the radiology doctor in the center he has chosen, and even if he does, he does not know that he has met; Unaware of the radiologist’s role in him and even that he is a doctor, he usually only deals with the secretary and technician, receives his report and goes to his ‘doctor’ without even having to read it; after all, “he will make the diagnosis” (!). 3.If after the examination he asks the radiologist about his breast, the radiologist’s response is: ‘Get your report, go to your doctor, he will tell you’.

The radiologist thinks that he is “good service” to the physician who sent him a patient; probably, that he is the one who must make the diagnosis and is unaware of the message it gives to the patient. However, in the patient’s perception, the radiologist says: “I’m not a doctor and I don’t know what’s in your breast. Your diagnosis will be made by your doctor who sent you to me”. This judgment is also shared by the requesting physician (General surgeon or Obstetrician) because the radiologist’s report is often vague, obscure, and overly cautious; It does not contain a definitive conclusion, comment and naturally (!), a recommendation. With this report, the patient comes to the office of the doctor who made the request. From the obstetrician’s point of view, this vague and suggestive report requires delegating responsibility to the general surgeon; In terms of general surgeon, it is usually BIOPSY…

What about the biopsy method? SURGICAL BIOPSY IS THE ONLY BIOPSY METHOD for 99% of general surgeons in Turkey.

With this scenario, thousands of women in Turkey are probably undergoing unnecessary breast biopsies every day. Thousands of other women sleep in the peace of having regular mammography screenings, unaware that they have cancer in their breasts. Of course, there will come a day and there is cancer in her breasts, but it is no longer at an early stage. In other words, neither life expectancy nor quality of life can be preserved. Those women who are meticulous about their health think that it is FATE..!

What about American and European women? They BUY quality in health services BECAUSE THEY DEMAND! They are demanding because they care about a long life with both breasts in place. They carefully select the radiologist for whom they will have their mammograms done and discuss their diagnosis with the radiologist doctors. There, 99% of breast biopsies are performed radiologically rather than surgically, that is, by a radiologist.

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