Book Articles

The Death of Mammography
by René Jackson, R.N., B.S.N., M.S. and Alberto Righi, M.D.,
Paperback, $19.95 ISBN: 0-9745245-3-0 February 2006

Faced with the prospect of litigation, the high cost of malpractice insurance, and low re-imbursement, radiologists across the country are refusing to read mammograms, and radiology residents are passing over breast imaging specialization. "The growing malpractice litigation frenzy in this country shows no signs of abating," say Rene' Jackson, RN BSN MS, and Alberto Righi, MD, co-authors of The Death of Mammography (Caveat Press, 2006).

"It is an important work addressing a crucial issue in women's health," comments
Pam Seay JD, Associate Professor, Division of Justice Studies, Florida Gulf Coast University. 

Leonard Berlin, M.D., F.A.C.R. Chairman, Department of Radiology Rush North Shore Medical Center Illinois, says the book is "…..a spellbinding 256-page volume that digs far beneath the surface of the “glossy veneer” typical of many books dealing with, and news media coverage of, breast cancer, mammography, and what the authors call the medical malpractice “lottery.”

"Ironically", says John Thomas, President, Chief Development Officer Cirrus Health in
Texas, "it is a book I would recommend to any woman who has been diagnosed with or wants to understand more about breast cancer, even though it is a sharp critique of the failures of our medical liability system in the U.S."

Florida Radiological Society

pointoflaw.com forum post February 07, 2006


"The Death of Mammography"

In the mail: "The Death of Mammography" by Rene Jackson and Alberto Righi. According to the publisher:

The best medical tool for detecting breast cancer is being driven to extinction by outrageous lawsuits, putting millions of women at risk. A practicing radiologist confronts the legislative and legal tangles strangling breast-cancer screening today and argues for reforms to our legal and healthcare systems.
Early detection of breast cancer can make the difference between life and death—and mammography is the best diagnostic tool available today. However, radiologists across the country, faced with the prospect of litigation and the high cost of malpractice insurance, now refuse to read mammograms. Radiology students are passing over specializing in breast imaging, and in the last few years over 700 mammography centers across the United States have closed their doors. Today, the number of women needing regular mammograms exceeds the capacity of the dwindling ranks of radiologists able and willing to read a mammogram.

More here, here and here.

Posted by Walter Olson at 12:12 AM | TrackBack (0)

The Death of Mammography

Is mammography slowly getting edged out of health care? Rene Jackson thinks so, and explains why in her new book, The Death of Mammography.

According to Jackson, because of the prospect of litigation and the high cost of malpractice insurance, more and more radiologists across the country are refusing to read mammograms.

She also points out the biology of breast cancer, explains mammography technology and speaks on current legislative and legal issues.

About the author: Rene Jackson, R.N., B.S.N., M.S. is a special procedures nurse in medical imaging at Charlotte Regional Medical Center in Punta Gorda. She is also the author of more than 40 health care and nursing articles.

Note: There are many books on health out there, so Feeling Fit will occasionally run a column called, Read this. This column will highlight a recently book dealing with diet , exercise or health. This column is not meant as an endorsement, just as an informative piece on what's available to the many Feeling Fit readers out there.

By Dawn Krebs
Interim Health Editor
The Charlotte Sun Herald, Jan. 8, 2006

RN CO-AUTHORS BOOK ON
MAMMOGRAPHY TRENDS


Rene Jackson, MS, BSN, RN, special procedures nurse in medical imaging at Charlotte Regional Medical Center, Punta Gorda, has co-authored an upcoming book, The Death of Mammography (Caveat Press 2005), which examines the effect of litigation and malpractice claims on mammography services.
The number of women needing regular mammograms outpaces the capacity of the dwindling ranks of radiologists able and willing to read a mammogram, according to Jackson and co-author Alberto Righi MD, medical director of a Florida radiology group. They say radiologists across the country, faced with the prospect of litigation and the high cost of malpractice insurance, are now refusing to read mammograms. Radiology residents are passing over specializing in breast imaging, and more than 700 mammography centers across the United States have closed their doors in the past few years, the authors state.
Jackson and Dr. Righi offer a comprehensive analysis of the crisis and specific solutions.
"The growing malpractice litigation frenzy in this country shows no signs of abating," Jackson said. "Delayed diagnosis of breast cancer is one of the most common and expensive malpractice allegations made against physicians today."

OCTOBER 31, 2005 • FLORIDA • advance FOR NURSES

Mammograms may be in danger, say authors

By: E'LOUISE ONDASH - For the North County Times

It's a topic that's been lurking under the radar for a few years, but it's about to surface with the appearance of a book to be published in November called "The Death of Mammography" (Caveat Press, $16.95). The book paints a picture of a world in the not-so-distant future that may have no mammography clinics.

How could this happen?

Several ways, said co-author Rene Jackson, a registered nurse who works in medical imaging at a South Florida medical center.

The public is grossly misinformed about the limitations of the mammogram, reimbursement rates for reading mammograms is low (Medicare pays $18), and litigation against the radiologists who read mammograms has mushroomed. As a result, more than 700 mammography centers in this country have closed in the past few years.

"Radiologists across the country, faced with the prospect of litigation and the high cost of malpractice insurance, are now refusing to read mammograms," Jackson said.

Also, faced with the legal and financial obstacles, the number of radiologists-in-training willing to learn about breast imaging has taken a dive.

Although the mammogram is the best thing we have today to detect breast cancer, said co-author Alberto Righi, medical director of a South Florida radiology group, "it's on a path of extinction because of our misconceptions. Mammograms can miss up to 30 percent of cancers."

Mammograms are less-than-infallible for several reasons:

The authors offer these actions as solutions to what they say is the impending crisis:

To maximize effectiveness of the mammogram, it should be used with breast self-exam and ultrasound, say experts. Self-exam can catch some things mammography misses, and some tumors can be seen only with ultrasound.

Detecting cancers at earlier and earlier stages poses some problems, Righi explained. Public health officials in the United States should consider comparing philosophies of detection and treatment with those of Western Europe, which has comparable technologies.

"Over there, they wait until a tumor grows to a much larger size before doing a biopsy," Righi said. "For every 10 biopsies done in the U.S., Europe does one. We find one cancer for every 10 biopsies and they find one cancer for every one biopsy, and survival rates are the same."

Will we wake up some day to find that mammogram centers have disappeared?

"I don't think that will happen overnight," Jackson said. "However, it is slowly evolving. It may seem like it's happening overnight to the public, but radiologists have been predicting it for several years."

To order the book, visit www.caveatpress.com.

Book Chronicles Demise of Mammography Clinics

By E’Louise Ondash, RN, contributor

A mammogram is the best tool available for detecting cancer, but it isn’t perfect.

In fact, the mammogram is a lot less perfect than most medical professionals and the public realize, and this ignorance is contributing to an ever-diminishing number of mammography centers in the United States.

Could we wake up some morning to find that there are no mammography centers in this country?

“I don't think that will happen overnight,” said René' Jackson, RN, BSN, MS, co-author of “The Death of Mammography” (Caveat Press, $16.95).

“However, it is slowly evolving. (The disappearance of mammography centers) may seem like it is happening overnight to those whose focus is not presently mammography, but radiologists have been predicting it for several years.”

Between 2001 and 2003, more than 700 mammography sites closed, according to an article in an American College of Physicians publication. And according to the American College of Radiology, applications for mammography fellowships have fallen by 75 percent in some medical centers, and “hundreds of breast-imaging radiology positions nationwide are going unfilled.”

The number of women who need annual mammograms is greater than the capacity of the dwindling ranks of radiologists who are willing to read them, Jackson said. “Radiologists across the country, faced with the prospect of litigation and the high cost of malpractice insurance, are now refusing to read mammograms.”

Jackson, a special procedures nurse in medical imaging at Charlotte Regional Medical Center in Punta Gorda, Fla., admitted that until she studied the problem, “I never knew what it took to read a mammogram or any other radiology exam. I . . . was amazed at the information out there, especially that malpractice litigation for failure to diagnose breast cancer on mammography is the most common and expensive allegation made against physicians.”

While researching for the book, co-author Alberto Righi, MD, medical director of a South Florida radiology group, found that “a lot of doctors and the general public don’t understand the issues that surround mammograms and what we’re facing every day.

Basically the mammogram is going to disappear soon because it is such a tricky thing to read. The tool, the eyes and the brain are not perfect.”

Righi was a defendant in a 2004 “failure-to-diagnose” breast cancer case that awarded the plaintiff $1.2 million.

Many factors contribute to making the mammogram less-than-infallible:

“I can’t live under a system that demands perfection,” said Righi, who no longer reads mammograms. “Not that I don’t want to be perfect, but the laws of science don’t allow me to be perfect.”

How did misconceptions about mammograms evolve?

“When mammograms first came out in the late ‘70s, they were found to be something that would help us find most cancers,” Righi said. “(Public health experts) had to teach millions of women to get mammograms because we could now find 5-millimeter cancers – the size of a pea – but what they left out is that mammograms can miss 20 to 30 percent of cancers.”

Mammograms must be used in conjunction with self-exam and ultrasound to increase the chance of detecting cancer, say experts. Self-exam can catch some things mammography misses, and some tumors can only be seen with ultrasound.

Some have suggested that MRI is a better visualization tool, but others argue that MRI is too sensitive. It may pick up more cancers, but “it can’t distinguish between cancer and everything else,” Righi explained. “MRIs are sensitive to cancers 90 percent of the time but specificity is only 20 percent.”

Economic issues also are responsible for the demise of mammography.

More than half of all radiologists refuse to read mammograms because of low reimbursement rates, according to the authors. For example, Medicare pays radiologists about $18 to read a mammogram. Some other economic factors:

Detecting cancers at earlier and earlier stages poses some problems, Righi explained. Public health officials in the United States should consider comparing philosophies of detection and treatment with those of Western Europe, which has comparable technologies.

“Over there, they wait until a tumor grows to a much larger size before doing a biopsy,” Righi said. “For every 10 biopsies done in the U.S., Europe does one. We find one cancer for every 10 biopsies and they find one cancer for every one biopsy, and survival rates are the same.”

The bottom line, he added, is that in the United States, despite the detection of extremely early-stage cancers, mortality rates are no different than in countries where detection is done at later stages.

“If the cancer is a less aggressive one, the woman won’t die,” Righi said. “If it’s an aggressive cancer, she’ll die anyway.”

“The Death of Mammography” goes beyond the problem cited in its title. The book discusses all facets of breast cancer – its history, prevention, diagnosis and treatment – and offers solutions to the impending crisis:

The American Cancer Society predicts that by the end of 2005, about 211,000 new cases of breast cancer will be diagnosed; nearly 41,000 of these women will die of the disease.

“The Death of Mammography” (Caveat Press, $16.95) is scheduled for publication in November.
Visit www.caveatpress.com.