The Mammography Quality Standards Act (MQSA) passed in 1992 requires an audit, but it is not adequate, according to John Ball, MD, chair of the Institute of Medicine (IOM) of the National Academies report urging better interpretations and higher reimbursement for mammograms.

Dr Ball told Patient Care that the effectiveness of mammography greatly depends on the human component—how well staff members interpret breast images. “To improve those interpretations, it helps for the radiology staff to have as thorough a medical history as possible,” advises Dr Ball. “If a patient’s mother or sister had breast cancer, for example, or if the doctor has felt a lump, get that information to the radiologist. That can prompt him to read the scans more accurately. Also give feedback to the radiologist so he can check his reads against what actually happened with the patient.”

Although the technical quality of mammography has improved significantly, questions remain about the quality of interpretation, which is subjective and difficult to measure. The IOM report recommends that mammography facilities be required to undertake 3 new measurements:

• The proportion of patients who are diagnosed with breast cancer after receiving a recommendation for biopsy as a result of the reading of their breast images
• Their cancer detection rate—the number of patients found to have breast cancer per every 1000 examined
• The proportion of patients whose mammograms revealed a possible abnormality.

The committee considered a number of other approaches for improving physician performance in interpreting mammograms, such as increasing doctors’ experience by boosting the volume of images that they are required to read. Currently, radiologists in the United States are required to examine 960 mammograms every 2 years, compared to 5000 per year in the United Kingdom.