Mammogram interpretation by physician assistants

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Abstract
The objective of this study was to determine whether a health maintenance organization (HMO) desirous of providing low-cost, quality mammography could employ physician assistants (PAs) to interpret mammograms under the supervision of HMO radiologists. After intensive training in mammographic interpretation, four PAs individually interpreted 727 mammograms of 470 normal breasts, 75 breasts with benign breast masses, and 182 breasts with cancer. The interpretations by the PAs were more sensitive and as specific as those made by six HMO radiologists who interpreted the same cases, and as effective as those by radiologists described in the literature. In receiver-operating-characteristic curve analysis, the areas under curves for PAs were larger than those under curves for radiologists. Interpretations by PAs took less time and cost less than did those by radiologists; the dispositions recommended by PAs were similar to those recommended by radiologists. We conclude that properly trained, evaluated, and supervised PAs can interpret mammograms. Legal, practical, and ethical considerations dictate that this can best be accomplished under the direction of radiologists who are well trained in mammography.