CoR Recommended Practice
The need for a Mammogram Disclaimer?
By Dr Evelyn Ho
Click here for the official COR statement - 22 September 2004
Education and communication is essential in reducing the possibility of litigation in the face of increasing use of mammography. As mammography gains acceptance as a tool for early detection of breast cancer – we have to be ready for the possibility of more missed cancers even in the absence of a nationwide screening programme in Malaysia.
Screening mammography imposes very stringent requirements in the production/acquisition/ interpretation of consistent high quality mammograms. In diagnostic mammograms, we are pre-alerted to where the lesion may be and will be more vigilant in looking for other lesions.
The mammogram must be interpreted with the clinical breast examination findings and there should be documentation of communication with the referring doctor in the event of finding of malignancy.
It is good practice to ensure that the patient undergoing the mammogram understands its use, limitations, benefits and what to do in the follow up. One cannot expect the referring clinician to be solely responsible for the patient’s unrealistic expectations of the mammogram and other breast imaging techniques. As it stands, the onus is on us to educate our colleagues in other fields of medicine (especially those who refer patients for mammograms) to understand the role, benefits and limitations of the mammogram including the indications in those who are young.
The College of Radiology Academy of Medicine of Malaysia (COR) recommends a disclaimer accompany each mammogram report. It is good practice to make this a routine. After discussion and feedback from the Mammogram Subcommittee of the COR and the COR Council – a standard Mammogram Disclaimer was agreed upon.
The statements were carefully worded in the interest of ensuring concise information in plain language that a layman would understand.
"The mammogram may miss up to 5-15% of cancers in the breast. The management of the patient should be based on clinical grounds."
This is only a recommendation in line with good clinical practice. The nature of each radiology or breast imaging practice is variable and therefore, modifications to the statements may be necessary.
Therefore it is not just the need for the disclaimer but education of both referring physicians and patients. In addition to the disclaimer, it makes good sense to have a Mammography Fact Sheet in simple language (depending on the demographics of patient visits - these should be in the main languages in Malaysia/state in your practice) to help patients understand the role of the mammogram in their health checkup.