Reducing Risk of Faulty Mammograms : Gov. Wilson signs key legislation, but national standards are also needed

Most women who get a mammogram, a quick and painless X-ray, are reassured that they don’t have breast cancer. But sometimes their mammograms are wrong. Dead wrong.

Mammography equipment can malfunction or be poorly calibrated, the woman can be positioned incorrectly, the X-ray film can be over- or underexposed or the image can be interpreted incorrectly. Mammograms are more difficult to read than other types of X-rays even when they are taken by skilled technicians using the best equipment.

For these reasons, among others, no mammogram can detect breast cancer with 100% accuracy (which is why the procedure is not a substitute for monthly self-examination). But mammograms are still the most advanced diagnostic tool now available.

Too often faulty mammograms indicate that women are cancer-free when in fact they have a breast tumor. To reduce the risk of incorrect mammograms, nine states have minimum quality assurance standards; however, enforcement varies considerably from state to state.

Gov. Pete Wilson just signed legislation that will improve standards in California. Since 1989, Congress has required mammography screening facilities that seek Medicare reimbursement to meet quality standards. The American College of Radiology (ACR) also has a four-year-old voluntary accreditation program for mammography facilities.

But this patchwork of state, federal and voluntary regulations does not ensure that the mammogram a woman gets in most states is accurate. The ACR estimates that two out of three mammography facilities fall short of its standards.

The federal Breast Cancer Screening Safety Act would require all mammography facilities to meet equipment and personnel quality standards. Introduced by Sen. Brock Adams (D-Wash.), the bill would also mandate inspection of facilities every year and recertification every two years. Violators would face federal sanctions.

The American College of Radiology, the American College of Obstetricians and Gynecologists, the American Cancer Society and almost 300 breast cancer groups support national standards and enforcement.

Early detection could save the lives of 30% of the women who currently die of breast cancer. A faulty machine or poorly trained technician shouldn’t be the difference between life and death.