Finding Waldo and Decreasing Legal Liability: A Breast Density Update

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Mark-Toatley2By Mark Toatley, CRA

(Republished from the Tuesday issue of Convention Daily with corrections from the speaker)

Bonnie Rush shared with the audience a topic that the she has a passion for and a personal connection to (breast cancer diagnosis for those with dense breasts). Once she shared that, I was sure we were all in for an educational treat, and Bonnie did not disappoint.

The presentation opened by raising one of the key questions set forth in the sessions title; namely, why should we care about finding Waldo? Of course, trying to find Waldo has proved historically challenging, and my concern about what the metaphor was referencing was answered early. Finding Waldo meant identifying the pathway to address finding cancer in those with dense breasts.

This session enhanced perspective and left attendees more knowledgeable by providing numerous facts through use of information, videos, humor, and conversation. I will not attempt to reproduce the myriad of facts and supporting information disseminated; I will instead urge everyone to download and carefully review this session’s slides at

Since part of the title brings it up, what is the legal liability? Breast cancer claims account for 44% of all malpractice claims. Moreover, juries are often more sympathetic to the patient (plaintiff) than the radiologist (defendant) because of the perception of the benefits of mammography. Legally then, the liability falls disproportionately on the diagnostician. Interestingly enough, the number one killer of women aged 40-55 is not accidents; it is breast cancer.

There are various types of breast density, and the ACR categorization of these types show the lowest cancer risk level being a breast that is almost all fatty tissue; the next level being scattered areas of density; followed by increasingly dense to extremely dense. More breast density correlates to less chance of accurate diagnosis using traditional means (mammography). Therefore, adding alternative screening technologies such as MRI, US, Molecular Breast Imaging, CESM, and WBUS to aid in diagnosis, forms part of the pathway to improved outcomes. Use of mammography for diagnosis of breast cancer in those with dense breasts was likened to looking through a window with snow on it, and trying to find a drop of milk. Please note that 57% of women in one survey felt that if they had a mammogram, they would not get breast cancer.

This was an outstanding session that help dispel the myth of mammography’s dominance as the early detection tool. It introduced alternative approaches and perspectives and provided a preponderance of evidence including breast density education, legal ramifications, and actionable steps toward raising awareness that ascertaining the status of those with dense breasts involves taking into consideration the use of technology, associated costs, exposure levels, symptoms and genetics. From these components, a roadmap can be developed that helps chart a course for improved results.

Bonnie Rush said it best: change the destiny of those with density!

One comment

  1. My thanks to Mark for this excellent work on providing salient information on my talk – and with heartfelt appreciation of the difficulty of leveling the playing field for women with dense breasts. I am so impressed he took the time to write this article.

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