Efforts to raise breast cancer awareness should not only include a search for a cure but also "improving access to lifesaving therapy for women already living with breast cancer -- many of whom don't even know it" -- according to a New York Times opinion piece by Mark Perlman, a professor of obstetrics and gynecology and director of the Breast Fellowship Program at the University of Michigan Medical School; Raymond De Vries, a professor of bioethics and obstetrics and gynecology at the medical school; and Ann Bell, a graduate student in sociology at the University of Michigan.
The authors write that delayed diagnosis of breast cancer "is the most common and the second most costly medical claim against American doctors." According to the Physician Insurers Association of America, there are five causes of delays in breast cancer diagnoses: misread mammograms, false negative mammograms, "findings that fail to impress the doctor," doctors failing to refer patients to specialists and poor communication between providers. Perlman, De Vries and Bell write, "Four of these five are preventable human errors (a false negative mammogram is a machine failure) and two -- failure to make a referral and poor communication -- are products of the way we organize health care."
The authors argue that the "breast is something of an orphan in our health care system." They write that despite the prevalence of breast cancer and a profusion of specialists for nearly every other area of the body, "we have no 'mammologists.' How did the breast get lost?"
The answer, they say, is related to "the division of labor in medicine and the history of specialization." Ob-gyns have "created a niche for themselves as 'women's doctors,' a kind of primary care specialty," and serve as the point of entry to the health care system for most women, the authors write. Although women with breast problems often start with their ob-gyn, they are also likely to require care from radiologists, radiation oncologists, medical oncologists, reconstructive surgeons and medical geneticists, according to the authors. "Women with breast cancer get lost in the mix, forced to make several different appointments, sit in various waiting rooms and see multiple doctors," they write. This is in "contrast ... with the care given to women with gynecologic cancer," who "see the same doctors from diagnosis to post-surgery follow-up," the authors write. They note, "Breast malignancies outnumber gynecologic cancers 10 to one, and yet we have no subspecialty for breast care."
The authors continue, "Women with breast cancer need [ob-gyns] who have learned how to diagnose breast cancers and breast care specialists devoted to shepherding them through surgery, therapy and healing." They add, "Given the haphazard growth in medical specialties and varied training programs for [ob-gyns], it is no surprise that there is a mismatch between patient needs and caregiver skills." They conclude that in addition to seeking a cure, campaigns for breast cancer awareness "must also seek to improve the way we organize care for those who suffer from this disease" (Perlman et al., New York Times, 10/10).
