October is Breast Cancer Awareness Month.
In a story in the Sedona Red Rock News on Aug. 31, “Missed breast cancer leads to loss,” Christine Gallo, a Verde Valley Medical Center employee, shared her story about how two radiologists who worked at Northern Arizona Radiology allegedly failed to detect cancer on her mammograms in 2017 and 2018. As a result, Gallo had a bilateral mastectomy or the removal of both breasts.
Even though Gallo was diligent in getting her mammograms every year, she became a statistic.
The National Cancer Institute reports that the overall five-year relative survival rate for breast cancer is 90% after being diagnosed. The 10-year breast cancer relative survival rate is 84%.
Early detection of early-stage breast cancer has a survival rate of nearly 100%.
Patients rely on their doctors and radiologists to identify cancer competently and as early as possible to have the best chances of recovery.
Unfortunately, radiologists who don’t detect lesions visible on mammography scans or 3D scans can face malpractice lawsuits. According to several law firms, breast cancer misdiagnosis is the leading cause of radiologist malpractice.
Dr. Beth DuPree, a board-certified general surgeon specializing in breast diseases, has been practicing medicine since 1987. She served as vice president of Holy Redeemer Health System in Huntingdon Valley, Penn., and has held an academic appointment as an adjunct assistant professor of surgery at the University of Pennsylvania.
DuPree moved to Sedona in August 2016 and began working for Northern Arizona Healthcare in April 2017. Her goal was to create one of the best breast cancer care centers in the country in Sedona.
DuPree says that early on, she began noticing missed cancer evaluations on mammography reports and demanded NAH have dedicated breast radiologists on staff who would detect abnormalities immediately.
“There are general radiologists who can do all aspects of radiology, and then there are physicians who go on to do additional training,” DuPree said. “I followed every appropriate protocol within a health system to provide quality and safety for patients, which I did by getting breast imagers here and making certain things like that mandatory.”
Because of her insistence, fellowship-trained breast radiologists were brought on board in 2019 by Northern Arizona Radiology, contracted to work with NAH.
Dr. Michael Ulissey is board-certified in diagnostic radiology and specializes in breast imaging. He was an adjunct professor of radiology at the University of Texas Health Sciences Center, former director of breast imaging at the University of Texas Southwestern Medical Center in Dallas and ran the Parkland Hospital Comprehensive Breast Center.
He was hired in December 2019 by NAR along with two other radiologists who are board certified and subspecialty fellowship trained in breast cancer, breast imaging, and clinically oriented breast radiology. They were hired to do a quality review on 13,675 breast images previously screened from 2016 to 2019 from patients from NAH’s, Verde Valley Medical Center. Their findings of missed cancers on mammograms and 3D imaging were extensive.
“Between 2016-2019, we found significant, severe and sometimes critical, unexplainable errors in judgment and clinical care,” Ulissey stated in reporting the final quality review results to NAH, their Board of Directors and NAR.
To provide women with the best health care recommendations, DuPree and Ulissey offered the following suggestions to help women become proactive in their health care choices.
“But the bottom line is, it needs to be read by someone who’s actually going to read the images, go back and compare those breast images to prior years, and who understands breast pathology extensively, which is why people do breast imaging fellowships or additional training,” DuPree said. “Breast imagers go into breast imaging because they want to identify cancers as early as possible so that patients have the best opportunity to treat cancer … we have better technology, but the better technology still requires a better-trained doctor to read it.”
Ulissey says reading a mammogram is what he calls “the 1,000 faces of normal.”
“If I show you an MRI of the brain — I can show you 100 brain MRIs,” he said. “If they are all normal, they all look the same. There might be a very tiny, normal variant difference in one or two of them, but essentially 100 brain MRIs that are all normal all look the same. One-hundred CAT scans of the abdomen that are all normal, all look the same; 100 CAT scans of the chest that are on the lungs and are all normal, all look the same. I can show you 1,000 mammograms — every one of them is normal. And every one of them looks different. That’s why I call it 1,000 faces of normal,” Ulissey stated.
DuPree and Ulissey agree that most OB-GYNs are not certified in reading mammography scans. “If you go in for a diagnostic mammogram, your [OB-GYN] will get a letter and you will get a letter [reporting the results of your mammogram],” Dupree said. “If a woman has something that feels abnormal, if they have a significant family history, if they have a genetic predisposition, they should go to a breast surgeon for a clinical evaluation to ensure that they’re not missing something.”
“A lot of people go to a hospital that does a little bit of everything,” Ulissey said. “So, you get a jack of all trades, but a master of none. In this day and age, you can send images to specialty centers with the beam of the internet. I don’t think there’s an excuse for women not being able to have their mammogram read by someone who specializes in only breast, radiology breast imaging and clinical breast radiology. We don’t yet have a specialty center in Sedona, the Verde Valley, or Flagstaff. But there are those types of centers in Phoenix.
“One of the best things women can do is to trust their intuition,” Ulissey said.