reading

The professionals presented their position on the suppression of double diagnosis It entered into force on March 1. If first the Ministry of Health opted for silence when asked about the recovery of the second reading, then stated that for a month there has been single reading “due to a circumstantial problem” which has already been normalized. When the second assessment was suppressed, they nevertheless pointed out that European protocols were followed.

The abolition of the double assessment of mammograms caused a huge uproar. The Alicante Provincial Association of Women with Breast Cancer defended that cross medical criteria to reach the most accurate conclusion possible about the scope that the disease can have It is essential because there are clear cases but others are very complex, “And if something is overlooked, the result can be fatal. We are not talking about something minor, but the woman risks her life if it is not diagnosed on time,” said Loreto Brotons, president of APAMM.

The double reading significantly reduces false diagnoses, both positive and negative, in fact it is a procedure that seeks to avoid errors. In its course, two physicians interpret the tests and contrast each other. If the radiologists differ on the diagnosis, it is repeated. Physicians believed that removing the second reading violated the program’s safety and quality assurance recommendations, and violated the regulations governing its development.

The different patient associations in the province described it as a cut that endangers women because in this disease the early diagnosis is essential and if it is detected late, the tumor can degenerate to metastasis. For this reason, they were preparing a formal claim before the Ministry of Health through the Spanish Federation of Breast Cancer (Fecma).

“It seems very good to us. They should not have been removed. Knowing that (the second reading) returns this month, we will be very attentive,” said the president of APAMM Alicante about the reversal of the Department of Health. The representative of this association understand in any case that there must be no suspicion of cancer to double read the mammograms but precisely the tests are crossed to eliminate that suspicion.

In the same line, Manuela Agulló, president of the Association of Women affected by Breast Cancer of Elche and region (Amacmec), considers that it is “extremely good” news. “We’ve made quite a bit of noise and it seems that they have backed down and reached an agreement”.

The associations of the province against breast cancer want to meet with Health leaders to elaborate on the age at which screening begins, 45 years, since they consider that it should be brought forward. “Apart from the second reading, more things are missing. We hope among all the associations to achieve it.”

Radiologists consulted by this newspaper have confirmed that Health promised to resume the second reading of the mammograms this month and what There have been calls to professionals to start again with the second reading in the units of Alicante and the rest of the Community. The indications about the recovery of the double interpretation of the mammograms are therefore verbal.

The professionals consulted point out that “It is a very consolidated program and regulated by law, You cannot go against the regulations if you mark both readings.” They also stress that the decision was made supposedly because there were insufficient personnel resources, “and that is not the case. There could be a unit that did not have a reader, but most units are covered by a first and a second reader. From today to tomorrow they told us to stop doing the second assessment when it is not true that there is a lack of personnel because there are radiologists to do the first and second reading.”

Sanitary sources abound in that It was also argued when making the decision that first they wanted to cover the first reading in all centers of the Valencian Community. The professionals agree that Health should focus on looking for the first and even the second reader in the units that do not have it, which It does not mean that services that have two radiologists have to be touched.

“It is not an acceptable measure that because some units do not have a second reading radiologist, none should have one.”

The experts consulted consider that the second reading could be suppressed in any case if conditions such as having state-of-the-art mammographers or replacing the radiologist with artificial intelligence, “it would be helpful, although there is no scientific evidence to justify it either. The regulations could only be changed using those arguments. But when you have resources and you throw them out, it is not understood.”

The suppression of the double reading in mammograms was initially denounced by the president of the PP and the Alicante Provincial Council, Carlos Mazón, who attributed it to the lack of radiologists, after recalling that in the Valencian Community these tests they had always been carried out under the supervision criteria of two specialists independently.

Health responded that European protocols were followed and that the Quality Guide breast cancer of the European Commission especially recommends double reading when those who assess the mammograms are non-expert radiologists (perform less than 3,500 studies per year). Likewise, from the Ministry they indicated that in case of even the slightest doubt about the results “the necessary readings and revisions will be made”.

The development of the Breast Cancer Prevention Program is regulated in Order 4/2021, of October 29 of the Department of Health, which is of application to all women between 45 and 69 years, having planned and announced progressive extensions up to 74 years.

In the methodology of the program, said order establishes that women must be scheduled for screening every 24 months. They will be given a mammographic study bilateral in two projections and a double reading in which there must be consensus. If there is not, a new assessment should be made to confirm the diagnosis.

no written order

The Medical Union has issued a statement in which they state that thanks to the pressure from medical associations, from professionals involved in breast cancer screening and from the union organization itselfthe Ministry of Health “has rectified and reintroduced, with good judgment”, the second reading of the mammograms in the breast cancer screening program, “which had been arbitrarily and unilaterally withdrawn without agreement with the professionals involved, communication that has been made following the same procedure as the withdrawal, that is, without a written order”.

This entity regrets, on the other hand, the lack of response to the explanations requested by the Medical Union on March 16 from the General Directorate of Public Health, requiring information on the workforce and functional organization of the Breast Cancer Prevention Units, as well as on the decisions regarding the withdrawal of the second reader that had been adopted.

The petition requested data on the Units that do not have an assigned radiologist and the name of the radiologist professional attached to each one that does have it. As well as which radiologists are assuming the first unit reading those that do not have a radiologist assigned as first reader and which ones they are; also copy of the instruction that eliminates the second reading of the program, or failing that, if there is no written instruction, the person responsible for said verbal instruction; copy of the notification that was sent to the radiologists who stopped doing the second reading and the regulations on which the decision to suspend the second radiological reading of the Breast Cancer Screening Program.