Mammography is a diagnostic test used for examining breasts with low-energy X-rays to detect breast cancer early. The mammogram uses ionizing radiation and creates images, which are then analyzed by radiologists to detect abnormal tissue growth. If a woman tests positive for breast cancer, the image will display microcalcifications or characteristic masses. However, the effectiveness of mammography is often disputed through clinical trials.
According to Gøtzsche and Nielsen (2009), the application of mammography reduces breast cancer mortality by 15 percent, but it also results in 30 percent increases in overdiagnosis and overtreatment. The sensitivity of mammographic readings has not been improving constantly, so researchers failed to find a significant relationship between mammographic quality and breast cancer mortality reduction (as cited in Gøtzsche & Nielsen, 2009).
It is also important to understand that clinical uncertainty influences the radiologists' discomfort and impacts the diagnostic interpretation of mammograms because of lower specificity and lower positive predictive value (Dick et al., 2009).
Mammography tests are often incompletely interpreted to patients because radiologists are reluctant in reporting errors that occurred while interpreting results (Gallagher et al., 2009).
Several controversial issues are related to mammography use. According to Gøtzsche, Hartling, Nielsen, and Brodersen (2012), 10 percent of women who attend mammography will encounter a false positive result. Apart from psychological distress and anxiety, treatment of healthy women can increase mortality rather than reduce it.
Despite some controversies on the topic, Teertstra et al. (2010) reported that mammography and tomosynthesis showed a sensitivity of 92.9 percent while their specificity was measured at 86.1 and 84.4 percent. However, it is important to consider that resolving clinical uncertainty in radiologists improves the quality of diagnoses. With that in mind, it is possible to conclude that mammography is currently the best tool for detecting breast cancer, but diagnostic standards and analysis protocols need to be improved to control clinical uncertainty and improve specificity and positive predictive values.
When conducting an assessment with a 40-year-old male who works 60 hours a week and uses Prozac, it is important to find the primary disorder and treating it rather than looking for temporary solutions to insomnia. Because the patient is a workaholic, he will most likely have rigid personal beliefs regarding the value of work (van Wijhe, Peeters, & Schaufeli, 2012) and various psychological issues (van Beek, Hu, Schaufeli, Taris, & Schreurs, 2012) that he will not admit, so I have to be sensitive when bringing up those topics.
In terms of socioeconomic conditions, workaholics have lower family values and poor social relationships outside of work when compared to other employees (van Beek et al., 2012). They often face exhaustion and burnout at work, so the speed of their working lifestyle often reflects on their health because they tend to neglect physical, mental, and spiritual well-being (Malinowska, Trzebir'iska, Tokarz, & Kirkcaldy, 2012).
Based on that knowledge, I would ask the patient the following five questions:
- How long have you had trouble sleeping?
- Have you noticed any health issues other than insomnia recently?
- On a scale of 1 – 10, how would you rate your stress levels?
- What do you consider the main reasons for your high stress levels?
- Have you considered cognitive-behavioral therapy to deal with the causes of your stress and improve your sleeping patterns?
The first question is designed to help the patient reflect on the issue and consider at which points certain life events may have induced it. The purpose of the second question is to identify potential risks that are often correlated with workaholics, such as risk of heart attack and low well-being, and plan reducing those risks if necessary (Malinowska et al., 2012). The third and fourth questions are designed to raise the patient’s awareness about his stress levels and reflect on what causes his stress. The fifth question introduces a solution to insomnia, but it is targeted at removing the causes of sleep disturbance for long-term results.
Although it is clear that the patient is a workaholic, who is most likely suffering from deteriorated cognitive performance and irritability, it is important to avoid bringing up those issues directly. Introducing new thinking patterns and behaviors over time through cognitive-behavioral therapy is the only way to avoid confronting the patient’s rigid belief system and improve the patient’s condition.
Dick, J. F., Gallagher, T. H., Brenner, R. J., Joyce, P. Y., Reisch, L. M., Abraham, L., & Elmore, J. G. (2009). Predictors of radiologists' perceived risk of malpractice lawsuits in breast imaging. American Journal of Roentgenology, 192(2), 327-333.
Gallagher, T. H., Cook, A. J., Brenner, R. J., Carney, P. A., Miglioretti, D. L., Geller, B. M., & Elmore, J. G. (2009). Disclosing harmful mammography errors to patients. Radiology, 253(2), 443-452.
Gøtzsche, P. C., & Nielsen, M. (2009). Screening for breast cancer with mammography. Cochrane Database Syst Rev, 4(1). 1-69. doi:10.1002/14651858.CD001877.pub3
Gøtzsche, P. C., Hartling, O. J., Nielsen, M., Brodersen, J. (2012, January). Screening for breast cancer with mammography. Retrieved from http://www.cochrane.dk/screening/ mammography-leaflet.pdf
Malinowska, D., Trzebir'iska, M., Tokarz, A., & Kirkcaldy, B. D. (2012). Workaholism and psychosocial functioning: individual, family and workplace perspectives. In A. G. Antoniou & C. L. Cooper (Eds.), The psychology of the recession on the workplace (pp. 59-88). Northampton, MA: Edward Elgar Publishing, Inc.
Teertstra, H. J., Loo, C. E., van den Bosch, M. A., van Tinteren, H., Rutgers, E. J., Muller, S. H., & Gilhuijs, K. G. (2010). Breast tomosynthesis in clinical practice: Initial results. European radiology, 20(1), 16-24.
Van Beek, I., Hu, Q., Schaufeli, W. B., Taris, T. W., & Schreurs, B. H. (2012). For fun, love, or money: What drives workaholic, engaged, and burned‐out employees at work? Applied Psychology, 61(1), 30-55.
Van Wijhe, C. I., Peeters, M. C. W., & Schaufeli, W. B. (2012). Enough is enough. Cognitive antecedents of workaholism and its aftermath: Manuscript submitted for publication. Human Resource Management. Retrieved from http://www.wilmarschaufeli.nl/ publications/Schaufeli/In%20press/Wijhe_HRM.pdf