Regulating radiology: ethical issues in mammography and federal legislation

One in nine women can expect to develop breast cancer over the course of a lifetime, which suggests that a posture of vigilance is appropriate. The form of breast imaging known as mammography will detect masses that self-examination and yearly clinical examinations may miss. Given that most types of breast cancer are not clinically preventable, early detection of such masses offers the best opportunity for survival for the affected women. Recognizing the need to ensure quality testing and interpreting procedures for so many women, the federal government has enacted legislation that requires breast imagers to read 240 mammograms in 6 months to qualify for certification and another 960 mammograms in the following 2 years. The burdensome nature of these requirements has had the effect of reducing the number of radiologists certified to read mammograms, and this has decreased the overall availability of this service to women. I explore two possible rationales for instituting such strict federal regulation of breast imagers: that breast cancer is more prevalent than other diseases that affect women and that legislating such high standards ensures the accuracy of interpretation. On neither ground is such legislation justified. Instead, I contend that this regulation was instituted as a way for politicians to make up for disregarding women and women's health concerns in the past by focusing on a current issue that predominantly affects women. As a consequence, I argue that more women may be harmed than benefited by such legislation.