“Everyone who comes before you” i do free mammograms I find it very objectionable that it comes out with the claim of ”.
It has caught your attention. Such advertisements always catch the public at their two weakest points:
one. “ It’s free “,
2. “ State of the art device from America “ have been brought. Whatever that means…
How confident do you think our people, who evaluate a medical service only for its fee, approach free meat on the street or free hair dye?
“ It’s free but how good is it? Maybe my notes below may be useful for those who question.
Our studies show that mammography practices in Turkey generally lack sufficient quality (1,2).
The reason for this is the insufficient number of mammography devices or the “ not being digital ” not!
Let me try to explain the real reasons:
1. Inadequate use of radiology devices.
The reasons for this are the lack of training of specialists, the effort of managers to limit the cost, and the society’s radiology services. from the device “There is a mistake of thinking that it is all.
For example, procurement laws suitability ” in its place “ be the cheapest ” condition.
“ The best quality ” in its place “ cheapest “The service is encouraged.
The service fees covered by the state are so far from covering the real costs that institutions that have to work with SSI are looking for a solution by minimizing costs and increasing the number of patients and relatively expensive initiatives.
One of the best-known ways of doing this is to force physicians to see the most patients in the least amount of time!
Patient density and unfavorable working conditions reduce the productivity of radiologists as well as all physicians.
According to the findings of our nationwide study published in 2007 (1), the tests that must be done every day to ensure quality images can be performed on only 7% of mammography devices.
In 20% of the centers, even the service maintenance of the mammography devices is not done at all, because it is trying to save the cost required for this.
Worse still, despite these conditions, 70% of radiologists report that image quality in self-assessed mammograms is “” very good or good ”, 21% of them “ moderately good He thinks it is.
In mammography very good Every quality level below ” of poor quality is synonymous with ” and “ very good ” Since it is known that quality can only be achieved with proper care and calibration, the finding I mentioned shows that the quality problem in mammography is extremely common in our country, while at least 70% of radiologists are not even aware of this situation!
However, image quality is vital because the radiologist he can’t see “It can’t even report cancer!
Radiologists who are aware of the risk but helpless “ skip a possible cancer “in the face of the threat” overdiagnosis ” and they suggest a biopsy very easily.
Since the majority of biopsies are performed surgically in our country, most of the breast surgeries are done unnecessarily!
A similar study published in 2012 and conducted only in Istanbul (2) proves that nothing has changed in terms of sensitivity to the subject in our country in the last five or six years.
Unfortunately, our researches do nothing but fill in files, those who try to tell what they know are ignored and ignored, and those who continue to try persistently, especially “ outrageously “If they try to warn the public, they are pruned and burned.
The most natural consequence of all this is misdiagnosis ” frequency (in the sense of both overdiagnosis and missed cancers) is extremely high and will continue to be so!
2. Mammography quality is not just about “image quality”.
Evaluation quality is equally important. Like other radiological methods, mammographic evaluation is the art of medicine and the field of radiology specialist!
Radiology residency, like most other specialties, requires four years of training after medical school. Then some radiologists want advanced specialization in a subspecialty. There are sub-branches of radiology as well as cardiology and endocrinology sub-branches of internal medicine; such as breast radiology, musculoskeletal radiology and nervous system radiology.
Radiologists with advanced expertise in breast radiology are very few in Turkey. The main reason for this is the Ministry of Health’s of breast radiology ” does not accept that it is a sub-branch that requires advanced specialization.
This situation creates a serious obstacle in front of specialist training and thus service quality.
In our country, the majority of mammography evaluations are those who have not received breast radiology training or have received insufficient training. ‘general radiologists’ and even by non-radiologists (experts of other branches).
These evaluations, which are unqualified, can do more harm to women than not to have a mammogram at all!
The radiation risk associated with mammography is nothing compared to the harm done by such shoddy assessments!
3. Another reason for poor quality evaluations is the way the patient applied to the radiologist and the attitude of the radiologist.
Since the diagnosis in breast diseases is mainly made by radiological methods, the healthiest way for patients is to apply directly to radiologists! However, it is traditional to apply to specialists from the wrong branch.
The way these specialists referred them to radiologists ( “Go get a mammogram and a breast ultrasound.” can lead to erroneous perceptions.
First of all, the patient should know that the diagnosis is made by the radiologist and not by the “ requesting examination from the radiologist ” he thinks he was put in by the doctor!
As such, radiological examinations are featureless and simple. from device output ” is perceived as only: “ All the same. Where would it be easier and cheaper to have it done?” Looking for a free center if possible.
Patients either never meet with a radiologist in those centers, or even if they do, they do not have the opportunity to talk.
Those who take the opportunity and ask questions to the radiologist usually get a pretty dramatic response: ‘ Take your report to your doctor, he will tell you what happened “.
By doing so, radiologists are unwittingly giving the wrong message to their patients that they are not responsible for the diagnosis, and that they are not even doctors!
Moreover, over time, they themselves believe this irresponsible and easy-going idea.
That’s why radiology reports are written ambiguously and overly cautiously, devoid of definitive interpretation and advice.
The patient, unaware of the role of the radiologist about him, receives this report and often does not even need to read it. requesting examination “She takes him to the doctor.
In a way, all that doctor could do (as it should be) was to convey the diagnosis written by the radiologist, in a way “ to translate It’s like nobody knows what it is!
Unfortunately, this translation is often inaccurate, as would be expected from any indirect communication.
As a result of all these, patients are faced with dramatic results such as unnecessary type or frequency of examinations, unnecessary or erroneous biopsies or missed cancers!
Every day, thousands of women in Turkey are unnecessarily undergoing breast biopsy!
Thousands of women sleep with cancer in their breasts, with the peace of having their scans that they do not know are of poor quality, even more often than necessary!
Of course, these cancers exist one day, but they are not in the early stage as they should be! Those women who are meticulous about their health think that it is FATE!
The essence of the word: The knowledge and experience of your radiologist changes your destiny, not the popularity of the devices that change with fashion or how often you go to the examination!
1. Diagnostic and Interventional Radiology 2007,13:129-133.
2. Diagnostic and Interventional Radiology 2012;18:468-472