Variability in the Interpretation of Mammograms

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Abstract
The findings of Elmore et al. (Dec. 1 issue)1 attest to the subjectivity and gross nature of mammographic findings. Considering that pathologists struggle with an accurate diagnosis even at more than 100 times the magnification of a mammogram, it is highly unlikely that greater accuracy in mammographic diagnosis will ever be achieved with current techniques. Unfortunately, the news media, having previously misled the public by overemphasizing the diagnostic potential of mammograms, are now heightening the apprehension of an already anxious population. The latest hoopla2 will stimulate the call for expensive second and third radiologic opinions and deflect attention from a vital point that is made in the editorial by Kopans.3 Mammography is an effective screening technique but not an accurate diagnostic technique. The essential purpose of a mammogram is only to demonstrate an important abnormality at the earliest possible time. A definitive pathologic diagnosis is to be expected in a very small proportion of cases.