John D. Keen MD, MBA, Presenter: Nothing to Disclose

Harry Brown MD, Abstract Co-Author: Nothing to Disclose

Shameem A. Abbasy MD, Abstract Co-Author: Nothing to Disclose

James Edward Keen DVM, Abstract Co-Author: Nothing to Disclose

Organizations including the American College of Physicians, the National Insitute of Health and others have promoted the concept of informed medical decision making regarding screening. We investigated the practices of a sample of "expert" mammography centers regarding this concept.

We assumed informed decision making requires balancing the marginal benefit with the marginal cost (including financial price). We assumed that "expert" mammography centers were represented by the 31 U.S. centers participating in the Digital Mammographic Imaging Screening Trial (DMIST) sponsored by the National Cancer Institute (NCI). In April of 2006, we called the center telephone number listed in the Food and Drug Administration (FDA) database of screening facilities. We asked for a recommendation from anyone for a website that could provide information about digital and screening mammography. We called a second time in March of 2007 and asked for the total cash price for a screening mammogram. We called additional numbers as needed. We also confirmed if the center used digital or computer aided detection (CAD) technology. We recorded the time it took to get an answer.

Regarding the first survey on websites, 5 centers had persistent voicemails, and 7 had no recommendation. Three sites could not be found, and 6 were hospital or radiology departments. Ten centers had balanced information: one had its own site, one recommended the NCI (www.cancer.gov) and one the American Cancer Society, while 7 had patient education sites linked to the NCI. Regarding prices, 27 of 31 centers provided total prices after a median wait time of 7 minutes. Twenty of 30 could answer the CAD question (13 yes). The median total price was $337 (95% CI 271-383).

Only 32% of centers recommended a website with balanced information about mammography. While 67% provided CAD information, 87% provided price information. Based on a small sample, it is debateable whether expert mammography centers promote informed decision making about screening.

Expert mammography centers can easily set a better example for the radiology profession as consultants in promoting consumer oriented education about screening.

Keen, J, Brown, H, Abbasy, S, Keen, J, Do Expert Mammography Centers Promote Informed Medical Decision Making Regarding Screening?.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5005091.html