In his Oct. 7 Outlook essay, “What the tests don’t show,” Daniel Morgan asserted that doctors don’t understand lab results. Mr. Morgan claimed that 5 of every 1,000 women will have a false-positive result and “will be told they have breast cancer when they do not.” There is no basis for that claim.
A “false-positive” mammogram occurs when a woman who has had a screening mammogram is asked to return for additional testing. If the additional tests, usually a few additional mammogram pictures or an ultrasound, prove negative, the result of the screening is called “false positive.” The woman is not told she has cancer when she does not. That would be unethical and has never been witnessed in my decades of experience in breast-cancer screening. Sometimes we can’t tell benign from malignant at imaging and must do a needle biopsy to prove whether a lesion is cancer. Again, we do not tell women without cancer that they have the disease.
This is Breast Cancer Awareness Month. Women deserve better information.
Debra Monticciolo, Temple, Tex.
The writer is a professor of radiology at Texas A&M University Health Sciences, vice chair for research and section chief for breast imaging at Scott & White Medical Center’s Department of Radiology.
Daniel Morgan failed to consider the role that psychological factors play in physician decision-making. He presumed that physicians approach medical care in a purely rational, calculating and logical manner, but many other factors influence health-care decisions. Risk tolerance is just one example of this that has been studied and found to affect physicians’ decisions in ordering tests and other aspects of treatment.
Other factors, such as patient-physician relationships, personal identification with patients and biases, also probably contribute.
Ilana Jackson, Baltimore