Breast imagers: Are you ready to field questions?

May 1, 2007

As a patient advocate, I am often asked how to choose a good breast care center. I've compiled a list of questions for women to ask prospective centers.

As a patient advocate, I am often asked how to choose a good breast care center. I've compiled a list of questions for women to ask prospective centers.

While answers to these questions may lead to a feeling of empowerment among women, the questions can also be instructive to breast imagers themselves.

With the Mammography Quality Standards Act up for reauthorization this year, it's possible the federal government will include more stringent outcomes metrics and oversight of adjunctive breast imaging modalities.

If that is the case-and even if it's not-breast imaging centers can only improve their quality by paying close attention to the detail in these questions.

Does your facility have dedicated breast imaging radiologists, who each read more than 2500 mammograms per year?

MQSA requires radiologists to read only 480 mammograms per year to remain qualified. Radiologists who specialize in breast care have better detection rates, recall rates, positive predictive value rates, and smaller tumor size detection than general radiologists who read only the minimum required number of mammograms.

For women participating in screening, what is the average size of the invasive breast cancers found by radiologists at the center?

The average/median size of screen-detected breast cancers should be less than 15 mm.

What is your center's recall rate for screening mammograms?

It should be less than 8%, as radiologists who read more mammograms have fewer false positives.

What is the positive predictive value of a positive diagnostic mammogram that requires biopsy?

The accepted range is 25% to 40%. The more experienced the dedicated breast imager, the higher the PPV.

Does the center have quality pathology services?

It is the pathologist who determines the type and extent of any cancer, and thus an accurate histological report is important in establishing what the treatment team will offer to the patient in planning therapy.

Does the center have a nurse coordinator/case manager?

The nurse coordinator helps guide the patient through the emotional chaos, the systems and appointments from the diagnostic through the treatment/rehabilitation phases of care, and acts as the patient's advocate.

Is there an up-to-date mammography screening program with timely appointments, quality staff, including mammography techs, and state-of-the-art technology including dedicated breast ultrasound, stereotactic-guided biopsy, computer-aided detection, and possibly MRI?

This paradigm facilitates improved diagnostic workups that are not delayed and provide the latest diagnostic information.

Is there a dedicated space to house the offices, equipment necessary to perform breast procedures, examination rooms, and interventional procedure rooms?

This plan allows for patient-centered care with efficient patient flow to coordinate and expedite care. The patient doesn't have to travel to various locations and get lost in the system.

Does the center conduct weekly multidisciplinary breast conferences where all specialists involved in breast care meet to discuss the care of each patient before treatment?

Such a process provides a conclusive plan for the patient's treatment, which is presented to the patient. She is aware that all disciplines have been involved and can make her decision based upon this knowledge.

Ms. Wagner is a retired ICU and home IV therapy nurse now working as a full-time patient advocate informing women of their breast biopsy choices and where to receive quality breast care. She has testified before Congress on breast screening topics.