Women know mammograms are critical. They help detect cancer early and speed the way to therapy.
But controversy has tainted the procedure for years, with confused women wondering: Who should perform my examination? Are all mammography machines equal? Does no news mean good news?
On Wednesday the federal government attempted to answer those and other questions by issuing mammography guidelines for women and their doctors.
The new measures, written by the U.S. Department of Health and Human Services, are designed to improve the quality of the examinations and ensure that the results are reported promptly.
They recommend that women have a mammogram only at FDA-certified centers. Clinics should use modern, certified equipment. And facilities are to report test results within 10 days. If a tumor is found, patients are to be instructed to make an immediate appointment with a physician.
The guidelines come on the heels of the Mammography Quality Standards Act, which regulates the machines and the people operating them at 11,000 mammography centers nationwide. The act took effect Oct. 1.
Where just weeks ago there was no regulation of a vital diagnostic technique, now there are rules and guidelines _ and free handbooks on the procedure in English and Spanish. The information is being made easily available through a toll-free telephone line.
"Mammography is important and women have to realize that," said Dr. Anne Claiborne, a diagnostic radiologist with a sub-specialty in mammography at Orlando Regional Medical Center.
Claiborne and other doctors acknowledge that unnecessary problems have plagued mammography in recent years.
Reports have surfaced that it can cause cancer. Disputes have arisen over the age at which screenings should begin. A lack of regulation has allowed some facilities to conduct the screenings with faulty equipment. And some clinics have failed to send test results to some women, giving them a false sense of confidence.
In some of the worst cases, results of positive mammograms _ those showing possible tumors _ were simply placed into some patients' medical files and not reported to them until their next clinic visit. For some that may have been weeks or months later _ a critical time period during which cancer could spread.
"I welcome the government regulation," Claiborne said.
Paula Zeller, of Health and Human Services' Agency for Health Care Policy and Research, said the new guidelines complement but do not duplicate the mammography regulations issued two weeks ago by the U.S. Food and Drug Administration.
Nancy Christiansen, a registered nurse at Florida Hospital who counsels women on mammography, warned that, even with the new guidelines and regulations, the onus is still on the individual woman to seek out the exams and ask questions about them. "The most important thing for a woman to know is that she is in charge of her own breast health."
Screening mammography involves taking low-dose X-rays of the breast. The pictures can reveal micro-calcifications _ the beginnings of a tumor _ only 2 to 3 millimeters in diameter, not much larger than the size of the period at the end of this sentence. Cancer of that size is too small to be felt by either a woman or her doctor.
TO LEARN MORE
Single copies of the booklet for doctors "High-Quality Mammography _ Information for Referring Providers" and the booklet for patients "Things to Know About Quality Mammograms: A Woman's Guide" are available at no charge by calling (800) 358-9295.