As patients and medical consumers, women have the right to inquire about the facilities and qualifications of the physicians performing any medical service or imaging exam. Because mammography plays an important role in detecting breast cancer at an early stage, often before a lump can be felt, women should choose a mammography facility with care. It is important to keep in mind that if a suspicious area is detected with mammography, a patient always has the option of having a breast imaging expert perform a second opinion interpretation of the films (assuming the images are of sufficient quality). Many academic medical centers provide such services.

The following are questions to consider when choosing a mammography facility:

Is the facility certified by the U.S. Food and Drug Administration (FDA)?

All mammography facilities in the U.S. must be FDA certified except Veteran’s Administration (VA) facilities. The MQSA (Mammography Quality Standards Act) certificate indicating that the facility is FDA certified should be clearly displayed. Patients should note the expiration date on the certificate. All mammography facilities must meet quality standards to receive certification.

Only Veteran’s Administration (VA) facilities are exempt from MQSA requirements. However, VA facilities have their own strict standards for ensuring quality facilities. All VA facilities must also be accredited by the American College of Radiology and are subject to annual MQSA inspections. Patients may locate the nearest VA facility by calling 1.888.492.7844 Monday through Friday 8:00 a.m. to 4:30 p.m. Eastern time.

On April 28, 1999, the final comprehensive regulations for mammography facilities went into effect. The regulations were developed by the FDA and the National Mammography Quality Assurance Advisory Committee and approved by President Clinton. The following regulations are required of every mammography facility in the United States:

* Physicians who interpret mammograms, radiologic technologists who perform mammography, and medical physicists who survey mammography equipment must have adequate training and experience (in order to be certified, each physician must document that he or she reads at least 480 mammograms each year; see below for a more detailed explanation of the importance of physician training).
* Each mammography facility must have an effective quality control program and maintain thorough records.
* Each facility must submit typical mammography images (x-rays) to the FDA for review. The FDA will evaluate the quality and amount of radiation used to obtain the images (radiation levels are required to be low).
* Each mammography facility must develop systems for following up on mammograms that reveal abnormalities, and for obtaining biopsy results.
* Each mammography facility must undergo yearly inspections by FDA or State certified inspectors.

While every mammography facility must meet these minimal requirements, there is still a tremendous variability in the quality of service between different facilities. Any licensed physician’s office can own and operate mammography equipment. However, the quality and skill is often quite different in the medical/OB-GYN facilities compared with radiology facilities. Women have a choice when it comes to where their mammograms are performed and are encouraged to choose quality over convenience in order to obtain the highest quality breast images and image interpretation available to them.

Does the facility have advanced mammography equipment?

Medical imaging technology improves at a rapid pace with the newest systems and equipment often providing better image quality in less time and with less radiation than older systems. Patients should seek to choose a center with the most modern and up-to-date mammography systems.

Does the facility specialize in mammography or perform many mammograms a day (over 15 to 20)?

Performing and interpreting mammograms is both a science and an art that comes with experience. Facilities that perform high volume mammography tend to have more experienced personnel, which usually translates into higher quality breast images and image interpretation. High volume facilities are also more likely to be able to justify the cost of modern mammography and other breast imaging systems which can be a key factor in achieving optimal image quality with the least amount of radiation.

Are the mammography technologists courteous and attentive to their patients?

Because the mammography technologists usually perform the actual mammogram exam, knowledgeable and courteous technologists can make the experience of mammography less stressful for patients. A recommendation from a friend or co-worker can be useful when choosing a facility. In addition, patients who are very apprehensive about breast compression during mammography may want to choose a mammography facility that allows patients to control breast compression themselves.

If a patient is not satisfied with the quality of care she receives at one facility, she should feel free to change facilities. However, it is important that she obtain her original mammogram films if she changes facilities so that future films may be compared to them.

Is there a specialized or dedicated radiologist on site to read the mammography films? Where did the radiologist receive his or her training?

Mammography may only be performed and interpreted in the U.S. by a licensed physician who meets the MQSA (Mammography Quality Standards Act) minimum standards. Furthermore, training and experience are essential in assuring an accurate diagnosis. Radiologists are physicians who are specially trained in the physics, positioning and interpretation of imaging studies. Some radiologists have further training (fellowships) in specific types of examinations and body systems, such as breast imaging or magnetic resonance imaging. The American Board of Radiology (ABR) examines and certifies radiologists. In addition, many mammographers belong to The Society of Breast Imaging, an international society based in the United States that is the leading organization of dedicated mammography physicians.

Radiologists with fellowship training in breast imaging or women's imaging (or have equivalent practical experience) tend to have more expertise when it comes to interpreting mammograms and other breast imaging exams than non-fellowship trained radiologists. In general, a radiologist with at least five years of experience in breast imaging is considered to have significant expertise in the field. Further, a recent peer reviewed study indicates that breast cancer detection is improved with mammography specialists who each read more than 4,000 mammograms per year. For example, a radiologist who reads 50 mammograms per day (devoting one half of his workload to mammography) reads approximately 5000 mammograms per year.

Does this facility also perform ultrasound-guided breast biopsy or stereotactic breast biopsy?

All mammography centers in the U.S. must receive MQSA certification in order to lawfully perform mammography. In addition, mammography centers may also choose to submit themselves for American College of Radiology (ACR) accreditation for providing ultrasound-guided breast biopsy and/or stereotactic breast biopsy. Presently, only a very select group of breast centers in the United States have applied for and received such accreditation from the ACR. Facilities that perform ultrasound-guided breast biopsy or stereotactic breast biopsy in addition to mammography tend to have significant expertise in the breast cancer diagnostic process. Patients may inquire as to how many stereotactic biopsies and/or ultrasound guided biopsies a radiologist performs each year to determine relative expertise for these procedures.