Patient callbacks are fairly common in mammography screening. Approximately 100 out of every 1,000 screened women are recalled for more tests. However, only 4 or 5 of them will be diagnosed with cancer. Recalls yielding benign outcomes have created negative effects on patients and, consequently, on radiology practices. But are the callbacks a bad thing? What are their costs and is there a way to mitigate them?
ACR recommends an overall recall rate lower than 12%
The American College of Radiology and the U.S. Agency for Health Care Policy and Research recommend an overall recall rate of 5-12% for screening mammography.
Recall rate by itself is used as a quality indicator by the federal government. However, we should keep in mind that the main objective of screening is finding cancers: this is why it is crucial to assess recall rates together with cancer detection rates.
A low recall rate may lead to low cancer detection. Whereas a recall rate beyond 12% shows little or no gain in the cancer detection rate with an increase in false positives exams. This can cause severe anxiety in patients when they are asked to return to the facility with a false-positive screening exam for further views. That alone decreases the patient experience.
What is more, recalls caused by false-positive mammograms and breast cancer overdiagnosis lead to important national costs estimated at $4 billion a year.
Callbacks affect patients
Women get yearly mammograms based on the recommendations of their primary care physicians as early detection can save lives. Being recalled is not something they expect or want.
Even though additional exams might be necessary for better cancer detection, it causes anxiety and fear, affecting general well-being, work, and relationships with family and friends. According to a study, recalled women even 3 years after receiving false-positive results reported greater negative psychosocial outcomes than the women with normal mammograms.
In addition to that, supplementary tests may negatively impact patients’ health as magnified views and tomosynthesis (in addition to the mammography itself) can mean more radiation for these women.
Apart from emotional and physical factors, recalled women incur financial burdens as they may find that they need to pay more for additional views or procedures. The most expensive additional exams include image-guided biopsies, MRIs and ultrasounds. For patients without adequate health insurance, these expenses can take a financial toll.
Consequences of callbacks for your radiology practice
Time issues
Women undergoing screening mammograms may often be called back for additional tests that can include diagnostic mammography, breast ultrasound, breast biopsy or magnetic resonance imaging (MRI). However, the rate of no-show for callbacks is high, and therefore the staff waste their time waiting for patients who will not come.
Clinic reputation
Patient recalls that do not result in detecting cancer contribute to their loss of certainty about breast screening value. In addition to that, it may affect clinic reputation and cause loss of trust in the specialists working at your facility.
This might prevent women from obtaining mammograms in the future. Women also make most of the healthcare decisions for their family and if they have a negative unsettling experience, they may not recommend the facility to their relatives and friends.
This is why it is important to reassure your patients and explain to them why they were recalled.
Financial costs
Fewer patients coming to your radiology practice can cut into your bottom line. As a business, imaging centers must keep their doors open to provide good care to the population of patients.
Artificial intelligence (AI) can help
AI-based software assisting radiologists in mammogram interpretation can be an efficient solution to mitigate patient callbacks. Innovative software increases breast imagers’ reading performance and reduces the false-positive rates while detecting cancers more accurately. This may help lower the recall rate at your practice if it’s on the high side or help you catch more cancers on time for a similar recall rate; it’s a win-win either way.
Patients have a choice with their mammography providers and a great experience will keep them coming back year after year. Patients want their radiologists to have confidence when reading mammograms, but they do know that human error and some cancers are missed. AI can help create a great positive experience for the physicians, giving them more confidence and for patients to trust the decision that the radiologists make.