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who tells patients of mammogram results? (especially if there is malignancy)
TLDR: Do you, the breast imager, contact and tell the patient of biopsy results/cancer diagnosis?
I had the bare minimum on my breast rotations and I recall that sometimes we’d tell patients if the results were negative. But residency was in a busy practice and I don’t recall too many encounters where we had to sit down and tell the patient of a cancer diagnosis. How do the breast imagers amongst you generally do this? do you leave it up to the PCP?
im really curious about differences in practices, especially cuz of a recent diagnosis in a family. -
16 Replies
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All over the map in my experience. Had clinicians outraged that a radiologist would break the news to the “their” patient. Also, had an OB/GYN say that radiologist get to skip out on the hard part of giving the patient their diagnosis. I know some radiologists feel it it their obligation to break cancer diagnoses, though I think most will do whatever the referring doc prefers.
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Quote from mathisfan17
All over the map in my experience. Had clinicians outraged that a radiologist would break the news to the “their” patient. Also, had an OB/GYN say that radiologist get to skip out on the hard part of giving the patient their diagnosis. I know some radiologists feel it it their obligation to break cancer diagnoses, though I think most will do whatever the referring doc prefers.
Most of our patients come from primary care. They are instructed to call their primary care provider for the path result, if they can’t get hold of the PCP, they are instructed to call us. I have never found this a difficult conversation to have.
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One should have conversations with your patients and your providers to find out what they prefer and expect. If one acts like a real doctor it tends to go well.
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In our breast care center, we always discuss the results of all diagnostic cases with patients and if biopsy is recommended we do them same day in 80% of cases. We are often in the position to tell them of path results, and we have a nurse navigator that will get them plugged in to a breast surgeon and an oncologist with appointments made before they leave the breast care center. We own it, the patients love it, we are their doctors and it is one reason we have a regionally dominant referral business for our breast practice. I believe this is the way it should be done, the primary care docs love this and are more than happy to not have to handle these issues as they cannot do what we can do for their patients.
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Oh, and there is rarely ever a reason to tell someone ‘you have cancer’. Its usually ‘I recommend we biopsy this to find out what it is.’
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If you see a BI-RADS 5 lesion, you should mention your suspicion of cancer to ensure the patient follows through with biopsy.
If you did the biopsy and rad-path correlation, you are in a position to tell someone they have cancer. -
Quote from fw
Oh, and there is rarely ever a reason to tell someone ‘you have cancer’. Its usually ‘I recommend we biopsy this to find out what it is.’
I believe people are talking about the result of the biopsy. Yes, of course one wouldnt say you have cancer based on imaging alone.
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The point some of us are trying to make here is that breast imaging is one of the few opportunities we have to develop a real doctor patient relationship. This should be encouraged in this time of PE incursion. Contrary to what some of us have been told by our colleagues, many if not most primary care docs are happy to give up that role. They have plenty of other work to do.
Of course there will be some that want to keep the communication between them and the patient. How do you find out? Pick up the phone and ask. You’d be amazed to find how much they appreciate the conversation and how that solidifies both your breast practice but other imaging referrals.-
Tough topic, I don’t know there is an official answer.
Logistically, our primary care docs and a breast cancer coordinator give the news for our patients. I find that a primary care doc who has known the patient for many years and has more of a relationship with them is better equipped – emotionally – to break the news, even if they cannot give the technical specs of the cancer and the treatment implications and risk of spread based on size etc, things that we can’t do very well either.
But sometimes – on their biopsy day – they ask me what I think of the mass or calcs and if I’m fairly certain that it’s gonna be a fibroadenoma or that it’s a BI-RADS 5 spiculated mass or ugly calcs, I will tell them what I think and not turf that conversation to someone else. The latter is difficult, as they sometimes break down and cry and I do my best to comfort them etc. Some rads have a policy of saying the same thing always: i.e. we won’t know for sure until we get the pathology results in a couple days, so no point in worrying right now, which is reasonable too. I used to do that, too.-
As usual you do a nice job of describing a real world practice that does it well. Definitely not one “official” answer. I do/did pretty much the same thing.
We now have a dedicated breast radiologist that is much more involved with patients and we are finding it to be a valuable experience for everyone involved. We definitely have those primary care docs that value the relationship with their patients and want to tell them personally. We know who they are and encourage that. I have also been surprised how many don’t care and are happy to give us the responsibilty. It’s in that scenario we can help if we are willing. It’s been good for our overall practice.-
When I worked in a university setting we would tell them if they had cancer after we FNA’d it. The patholologist would do the cytology right in the room.
That was the only practice where I told them they had cancer. I will ease them into it during the workup. If they don’t have a history of regular mammo I am more frank about the probability of cancer to scare them into following up.
The only person I ever told they had cancer off of a mammogram was my mother. I told her off her screening exam because she was resistant to following up as we were preoccupied with taking care of my father. That happened my first month as staff doing breast imaging. -
We (the breast imagers) used to call the patient with positive results. However, given the size of the practice, it was often the case that the breast imager calling the patient was not the same one that did the work-up or biopsy. Now, the nurses call the patients with results. This works well as they already have a relationship with the patient and can spend as long as they need to on the phone.
When I recommend or do a biopsy, I always tell the patient what I think. I always mention the word cancer, even if it to say that I think that a cancer diagnosis is unlikely. I’ve been doing this long enough now to multiple instances of minimally complicated cysts that collapsed that turned out to be cribiform DCIS, things that looked like fibroadenomas be IDC, and benign looking asymmetries be ILC.
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Quote from Thread Enhancer
Quote from fw
Oh, and there is rarely ever a reason to tell someone ‘you have cancer’. Its usually ‘I recommend we biopsy this to find out what it is.’
I believe people are talking about the result of the biopsy. Yes, of course one wouldnt say you have cancer based on imaging alone.
You would think so. Yet that is exactly what some cold fish of a radiologist did to my mom after a screening mammogram about 20 years ago. Didn’t get up from his chair, pointed to her mammogram and said ‘this is clearly cancer’. He was correct on the facts, yes this was a birads-5 lesion, but this was not the right way of going about it.
With a path result, I am rarely in a situation where I have that conversation face to face. I happen to think that their primary care doc or NP is in a better position to give them the path result. Sure, I know what needs to be done, but I am not conceited enough to think that I am any more valuable than their PCP who knows their history and has their choice of medonc and surgeon he/she refers to. I have had PCPs call me ask me to give the path result, and that’s fine too, I’ll gladly do so. Some patients dont have an established PCP and just go to a ‘doc in the box’, in that case they are probably better off talking to me.
Occasionally, when I consent someone for a biopsy, they ask me what I think it is, and I remain non-committal at that point. ‘The only way to find out is by getting a piece and sending it to pathology.’-
Conceited is a strong word there fw. You are doing a great job it sounds like. I am not suggesting everyone do it this way. I never have. There just happens to be an opportunity to build that type of practice if one chooses to. I believe this is good for the practice of radiology as a whole.
In general we are not the best people to give results to patients. We dont have the relationship built. However I am impressed by the relationships our breast specialists have built. Its good for them, the patient, the PCP and our practice.
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I feel out the situation, but most of the time Ill tell them the probability of what I think it will be. Most of the time I have a pretty good idea whether it is going to be benign or cancer, and in the few instances I really am not sure I tell them I dont know. I do spend quite a bit of time discussing things with them, and a lot of the time I am the one to tell them they have cancer when the path results come back. From a logistical standpoint it would be difficult to bring every patient back to meet in person, and if the primary wants me to give the news, I want to the patient to be prepared to know that it is cancer when I call. Ideally it would be in person, but difficult to do.
Some patient have a long time relationship with their PCP, but often they are younger and dont , or get bounced around different NPs and PAs.
Almost always the patients appreciate the honesty (if they asked me what I thought, and it was clearly a cancer, and I said I dont know that wouldnt sit well with me). The other rads in my group dont do this, and dont feel comfortable doing this. I do tend to get more thank you letters and dessert drop offs from the biopsy patients, though.
Whatever makes the patient and you most comfortable is the best answer.
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Quote from west323
Almost always the patients appreciate the honesty (if they asked me what I thought, and it was clearly a cancer, and I said I dont know that wouldnt sit well with me). The other rads in my group dont do this, and dont feel comfortable doing this. I do tend to get more thank you letters and dessert drop offs from the biopsy patients, though.
Lol. Yeah, baskets of garden grown vegetables, dessert drop offs and christmas cards tell you that you are doing something right. I think I need to work on that aspect of my practice 😉
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