"We can't overwhelm the few radiologists that we have, so we need to make sure that the radiologists are effective in what they're seeing, without having a negative impact on patient care," says Vandergrift.

Radiologists who interpret mammography images are the typical defendants in breast cancer malpractice suits.

"People have not gone into mammography screening and some of the fellowships have been empty - although it is a little better now - because all mammographers are at risk of malpractice and reimbursement rates are very low. It's not a good scene for people to be attracted to," says Dr. Blake Cady, staff surgeon at the Cambridge Breast Center, Massachusetts and professor emeritus of Harvard University Medical School and the Warren Alpert Medical School of Brown University.

Many breast imaging experts say that medical malpractice reform is essential for the future health of the industry.



Recommendations Ignite Controversy
Last November, a set of recommendations published in the Annals of Internal Medicine sparked a firestorm in radiology. In its updated guidelines, the U.S. Preventative Services Task Force (USPSTF) recommended against routine mammograms for women ages 40 to 49 and endorsed biennial rather than annual mammograms for ages 50 to 74. Some organizations, like the American Cancer Society and the American College of Radiology disagreed with the new recommendations. Other groups like the National Breast Cancer Coalition and the National Women's Health Network supported them. Many radiologists expressed outrage about the panel's guidelines and methodology.

"The idea of just not screening at all sets breast care back 40 years to the time where patients were diagnosed with breast cancer only when it presented as a mass or you could see it with your eyes. By that time, cancer is generally incurable," says Dr. Levine. "By not screening, we're simply sentencing patients to death, young women. It really makes no sense at all."

Many women expressed concerns about how the USPSTF recommendations would affect insurance coverage for mammograms. Numerous breast care centers put out statements to help their patients and colleagues interpret the recommendations. In a letter sent out to the medical staff of the Centra Health Medical System in Virginia, Dr. Matt Foster noted that 248 women between the ages of 40 and 49 were diagnosed with breast cancer within the last five years in the community. If the Task Force recommendations were adopted, "90 percent of these women would have gone potentially undiagnosed," he writes.

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