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Catch phrases are clever constructions that titillate, a certain combination of sound and metaphor that makes them easy to remember and likely to be understood when used. For instance, "hot tamale" and "mad cow disease" come to mind. Catch phrases can be useful. They are the lifeblood of advertising—the catchier the phrase, the better; for instance, "Um-um-good, that's what Campbell's soups are, um-um-good."
However, once a catch phrase gets into the hands of others, it may be bandied about for good purpose or bad. Words and phrases can then take on new meaning. Catch phrases can take on lives of their own—a life that may differ from the original purpose, and may even reverse the original intent.
Leonard Berlin [1] addresses several of the continuing controversies surrounding the impact of mammography on breast cancer. These controversies make mammographers seem the Rodney Dangerfields of imaging: "They just don't get no respect!"
Some of the controversy is centered on the meaning of catch phrases like dot size. The phrase "dot size" was originally used in an advertisement to encourage women to undergo screening mammography. You may have seen the ad (in fact, it is reproduced in Berlin's article). A minute dot is said to be the size of a tumor that can be revealed by mammography. The minute dot is compared with a large dot representing the size of a tumor that would likely be found by self-examination. The implication of the advertisement is intuitively obvious. Everyone would naturally assume that it is better to find a cancer when small, the smaller the better, than to wait until the cancer becomes large; therefore, screening mammography has distinct advantages over breast self-examination. Most of us would hold this to be instinctively true. But there remain detractors who would still argue the point that a smaller "dot size" is not necessarily better when it comes to cancer.
Detractors and doubters of the value of mammography contend, "Yes, mammographers may find tumors earlier, but `dot size' doesn't make any difference. The cancers are just smaller when found but, ultimately, the outcome is the same. Finding cancers earlier is just a matter of `lead time' [invoking another catch phrase] and besides you find a lot of cancers by mammography that would never grow sufficiently to affect the life of the patient, and many that you do find are not really cancers anyway," and on and on, "yah-dih-dee, yah-dih-dee, yah-dih-dee, dah."
It seems that nothing you say to those who hold such views is going to change their minds. Attempting to acquaint these folks with the facts regarding mammography may prove to be a Sisyphean task. You could get seriously paranoid if you had to deal with these people every day. Maybe these folks are blinded by the chips on their shoulders. OK, I realize that, anatomically and physiologically, it is just not possible for a chip on the shoulder to impair vision; therefore, I am forced to conclude that blindness to the facts must be one of their inherent characteristics, intrinsic to their mindset.
Dr. Berlin's article [1] is a thorough and highly informative discussion of the controversies that continue to swirl around the effectiveness of both diagnostic and screening mammography, controversies with which all radiologists should be familiar. At one time or other, we are all likely to find ourselves defending our specialty against those who would question the contributions of mammography in the struggle against breast cancer. To argue effectively, spend some time going over this piece and Berlin's related article [2] concerning the limitations of mammography. Acquaint yourself with the facts. This month Lenny provides all these facts and more.
Speaking, as we were, of dot size brings to mind another interesting and informative article by Zagoria et al. [3] concerning the imaging of other dots—in this case, urinary calculi and, more specifically, the appropriate imaging procedure to use in the follow-up of urinary calculi once identified. This article also supports my contention, discussed last month [4], that the source of most problems is previous solutions. In this case, the problem arises as a result of the shift from excretory urography to CT as the primary means of evaluating urinary calculi. The shift occurred, of course, because CT is more sensitive than radiography; CT is able to reveal more calculi than excretory urography. The precise question addressed by Zagoria et al. is, "Now that we have identified this calculus by CT, can we follow the course of the calculus with KUBs or will we have to resort to repeated CTs?" These researchers have found a simple way to make this determination based on dot size, the size of the calculus, and its density. A neat graph summarizes their findings.
"Leave no stone unturned!" "Check it out!" To dredge up still more catch phrases.
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