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1994.10.19 :  New Mammography Guidelines

Contact:  AHCPR - 301/594-1364
          Bob Isquith  ext. 173
          Bob Griffin  ext. 169
          Paula Zeller ext. 148
Wednesday, Oct. 19, 1994

             AHCPR ISSUES NEW MAMMOGRAPHY GUIDELINES   

                      
     New clinical practice guidelines released today by PHS' Agency
for Health Care Policy and Research recommend ways to improve the
quality of mammography and its potential for reducing deaths from
breast cancer.  The guidelines clearly outline the roles and
responsibilities of each health worker involved in the mammography
process and of the woman undergoing mammography. 

     HHS Secretary Donna E. Shalala said, "A key recommendation is
that mammography facilities give the woman the results of her test
in writing on site or by mail, usually within 10 days." 

     Shalala said many women never get their mammogram results or
get them late due to communications breakdowns or confusion as to
who will deliver the results. 

     "Such errors are unacceptable," she said. "They can cause a
woman needless anxiety over a mammogram that is perfectly normal, or
worse yet, can result in treatment delays or other consequences for
a woman whose mammogram is abnormal."

     Philip R. Lee, M.D., HHS assistant secretary for health and
director of the Public Health Service, said, "The guidelines will
strengthen the ability of women to interact with their provider,
fully aware of the type and level of service to which they are 
entitled.  These guidelines will also strengthen the effectiveness
of the Mammography Quality Standards Act.  The act, which went into
effect Oct. 1, establishes quality standards for mammography
equipment, personnel, radiation dose, record keeping and reporting
and requires facilities to be certified by the Food and Drug
Administration." 

     According to AHCPR Administrator Clifton R. Gaus, Sc.D., one
goal of his agency is to increase consumers' ability to make sound
choices in health care.  He said, "Women can and should influence
the quality of their mammograms. Some ways a woman can do this are
by making sure the facility is FDA-certified, asking when she'll get
the results, and writing down the name of whom she should call if
she doesn't.  Never assume that no news is good news."  

     AHCPR and FDA are widely distributing a consumer version of the
new guidelines in English and Spanish.  The professional versions
are intended for family physicians and other providers who refer
women for mammography, radiologists and other facility staff.

     Lawrence W. Bassett, M.D., the Iris Cantor professor of breast
imaging at the UCLA School of Medicine's department of 
radiological sciences, was co-chair of the private-sector panel of
health experts and consumers that developed the guidelines.  He
said, "Painful breast compression can be a problem.  Even one bad
experience with mammography can dissuade a woman from having future
screenings."  

     According to Dr. Bassett, the guideline panel took a broad view
of mammography services, starting with the time a woman or her 
health care provider calls to schedule mammography and ending with
tracking, monitoring and follow-up.

      Roughly 182,000 new cases of breast cancer are expected this
year and one woman in eight will develop breast cancer in her
lifetime. At current rates, about one woman in 33 will die of breast
cancer.

     Susan Blumenthal, M.D., M.P.A., PHS deputy assistant secretary
for women's health, said, "Mammography can be life saving.  These
guidelines, coupled with the FDA seal of approval for mammography
facilities, are an important step forward in improving the health of
American women."

     Panel Co-Chair R. Edward Hendrick, Ph.D., an associate
professor of radiology and chief of the division of radiological 
sciences at the University of Colorado Health Sciences Center in 
Denver, said, "Women should schedule screening mammograms when their
breasts are least tender and avoid using powders, lotions or
deodorants the day of their test, because they can affect the
quality of mammograms."

     Hendrick added, "It's also very important to bring as much
information as possible about previous mammograms, along with copies
of the x-rays when possible, and the name and address of the
providers who ordered the tests."  

     He said women should follow their health care provider's
recommendations for follow-up health care and ask any questions they
have. 

     The guidelines also say that:  

-- Mammography should be performed only with high-quality, modern,
dedicated x-ray equipment and with film processors set up
specifically for the mammography film being used.

-- Personnel who supply mammography services, including radiologic
technologists, interpreting physicians and medical 
physicists, should be qualified through appropriate training,
experience, certification and licensing.

-- The mammography facility should have an effective, ongoing
quality control program that includes annual evaluation by a
qualified medical physicist and more frequent quality control
tests at specified intervals by a qualified radiologic technologist.

     The panel, which included radiologists, family practitioners,
radiologic technologists, medical physicists,
a surgeon, an obstetrician-gynecologist, an oncologist, a
pathologist, a nurse and two consumer representatives, reviewed more
than 1,500 articles in developing the guidelines.  The guidelines
were reviewed by other mammography experts before publication by
AHCPR.   
     
     Single copies of High-Quality Mammography--Information for
Referring Providers: Quick Reference Guide for Clinicians and Things
to Know About Quality Mammograms: A Woman's Guide (in Spanish Lo que
la mujer debe saber sobre los mammogramas (rayos-x del seno), are
available free of charge from the AHCPR Publications Clearinghouse
1-800-358-9295, P.O. Box 8547, Silver Spring, Md. 20907.  These
documents also are available free from AHCPR Instant Fax (301/594-
2800) 24-hours a day, seven days a week.

     The 170-page Quality Determinants of Mammography, Clinical
Practice Guideline Number 13, is sold by the Superintendent of
Documents, U.S. Government Printing Office, Washington, D.C. 20402.

     The new guidelines are the 13th published since 1992 by AHCPR,
one of the eight agencies that make up the Public Health Service in
HHS.
                               ###