The politics of mammography

Mammography has had a major impact on the earlier detection, treatment options, and management decisions and survival and mortality rates of breast cancer. Consequences include overwhelming demand for mammography; problems with optimum response by radiology; limited availability of the examination, especially to the socioeconomically disadvantaged; self-referral for mammography by unqualified physicians for less than altruistic reasons; and unrealistic expectations of mammography by women, physicians, and lawyers. Responses to the overwhelming demand for high-quality mammography include ACR postgraduate and continuing education courses and its mammography accreditation program; a more comprehensive examination on mammography for certification by the ABR; and increasing state and federal government interest and legislation for reimbursement, quality assurance, and delivery of mammography. The precedents this sets for radiology if not all of medicine suggests that collaboration of the private and public sectors offers the greatest promise of an appropriate response, namely reproducible optimum mammography accurately interpreted with the lowest possible radiation dose for all eligible women in the United States.