Mammogram Facts and Laws
Two hundred thousand women are diagnosed with breast cancer every year. Forty thousand don't survive. Mammography, properly conducted, is still the best tool for early detection of cancer. But what happens if a woman opts for the test and the person reading it isn't up to the job? How is she even to know? That's the subject of this special report produced with THE NEW YORK TIMES. A year long investigation by THE TIMES, published this week, found that many of the 20,000 doctors who read mammograms lack the necessary skills for the job. What can you do to protect yourself?
LAWS AND PROTECTIONS
In 1990 Congress passed the Breast and Cervical Mortality Prevention Act. This act authorized CDC Centers for Disease Control to provide breast and cervical cancer screening services to women without regular access to such services. In the Breast and Cervical Cancer Prevention and Treatment Act of 2000 the eligibility regulations of the program were extended to include even more women from financially strapped and ageing populations. Every state now has a Breast and Cervical Cancer Prevention or BCCP program.
Many more women are having mammograms in the decade since Congress passed the first bill. According to The Centers for Disease Control, the number of women over 50 who have had a mammogram in the last two years has more than doubled in that time to almost 75%. Indeed, some major health insurance plans send reminders to female plan members who have missed annual mammograms twice in a row.
The 1990 bill also provided for a measure of standardization in the procedure, requiring certification of clinics offering mammograms. However, as THE NEW YORK TIMES and NOW's investigative report has shown, these measures may not be enough.
On their Web site, the FDA posts its guidelines for "the Mammography Quality Standards Act (MQSA)." They require that "the interpreting physician has met the requirement to interpret an average of at least 40 mammograms per month over a 24- month period. Failure to have adequate documentation will jeopardize a physician's eligibility to interpret mammograms, as well as subject the facility to a finding of noncompliance at the time of inspection." According to studies cited by the NEW YORK TIMES, "doctors need to read at least 2,500 films each year to stay sharp, the government mandates a mere 480, a number many experts say is so low as to be virtually meaningless."
In "Radiologist Roulette" cancer survivor and medical physicist Trisha Edgerton gives advice to women on how to get a good mammogram reading. Among the key factors are:
- find a clinic where doctors read large numbers of mammograms (many more than the FDA's 480)
- Insist on having your films read by the "lead interpretive physician," who oversees a clinic's quality controls.
- Look for clinics where two doctors independently interpret every film.
- And, above all to ask questions
Facing a cancer diagnosis is a frightening prospect. Just as a woman must rely on herself in getting a good mammogram reading, a cancer patient can take an active part in her treatment. Below are a list of questions for your doctor from cancerandcareers.org, a non-profit group dedicated to helping women live and work with cancer.
Five important questions to ask your doctor
Important things to know about your doctor
- What is the primary site of the cancer
- What grade is it? (How aggressive is the cancer?)
- What state is it in? (What is the extent of the cancer?)
- What is the likelihood of the cancer spreading and/or recurring in a new part of your body?
- What is my prognosis?
- Is he/she board-certified and in what speciality?
- How long has he/she been in practice?
- What training and experience does he/she have in treating your specific cancer?
- Is he/she involved in any clinical trials for new treatments for this type of cancer?
- What is his/her primary hospital affiliation?
- How often has he/she performed the surgery/treatment he/she recommending?
- Who covers for his/her patients when he/she is unavailable or out of town?
- Does he/she work other professionals such as social workers, nutritionists, pharmacists and counselors if you need them?
- Can your blood work be done in the office or will you have to go to a different location?
For more important information visit our resources section.