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MAMMOGRAPHY:
Your Patient May Know
Before You Do!
By Philip Unger, M.D.,
Medical Director
Department of Radiology,
St. Jude Medical Center
Co-Director, St. Jude Breast Center
Member, MPT Board of Trustees

Too often, communication breakdowns may delay the diagnosis and treatment of early stage breast cancer. The federal Mammography Quality Standards Act of 1992 (MQSA) sought to remedy this. The final MQSA regulations, effective as of April 28, 1999, require that mammography facilities provide an easy-to-understand written summary of the results to every patient. Prior to the MQSA, mammography facilities were not required to communicate results directly to patients. Generally, results were furnished only to referring physicians.

Patients must receive a written report of "negative" results within 30 days. However, results that are "suspicious" must be communicated "as soon as possible." While these results may be given to the patient verbally, in person, or by telephone, a written summary is still required.

What does this mean to CAP members serving in Primary Care roles?

• All mammogram results should be screened immediately upon receipt. Abnormal results should be promptly brought to the physician's attention.
• If the mammogram is abnormal, anticipate that your patient may call about the result before you have even read the interpreter's report. The written summary will recommend further investigation or another imaging study, and will instruct patients to contact their primary health care providers.
• Actively pursue evaluation of abnormal results by scheduling your patient for a breast physical exam, further imaging studies, and referral to a specialist, if indicated. Also, a detailed family and medical history often provides essential information. Do not allow this patient to "fall through the cracks."
• Abnormal results, especially those received after 5:00 p.m. on Fridays, could cause much anxiety. Your patients will need reassurance by Monday morning.
• Ask your mammography center to provide you with samples of patient letters they use to help you deal with questions about the summaries. The Agency for Health Care Policy and Research (AHCPR) has developed sample letters for use by mamographers. They are posted on the Food and Drug Administration's web page at www.fdg.gov/cdrh/dmqrp/guidance.html

The MQSA also clarified a facility's responsibility to retain mammograms for 10 years and to provide mammograms to a patient's physician, or to the patient directly, upon request. This aids diagnosis, allowing doctors to compare older mammograms with the new ones.