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http://www.nytimes.com/2002/06/27/health/27SIDE.html

Tips on Mammography Clinics

By THE NEW YORK TIMES

r. Barbara Monsees headed the expert panel that helped write the federal mammography rules. But when women ask her where to get a good mammogram, she does not tell them to look for the government seal of approval. "I tell them to go to a place where people specialize in mammography," she says.

Comparison shopping for mammograms is not easy. The government does not gather much of the information that experts say women need. Women in rural areas may have to travel long distances to find doctors who meet the experts' standards. Some doctors may bristle at being grilled. Even high-technology radiology clinics in fancy neighborhoods may be staffed with doctors who do not have the training, experience or knack to read mammograms well.

When asked how they advise family and friends, several experts offered these thoughts:

DO's

Find a clinic where doctors read large numbers of mammograms, far beyond the 480 a year required by the F.D.A.

Insist on having your films read by the "lead interpretive physician," who oversees a clinic's quality controls.

Look for doctors who did fellowships in mammography, or those who spend at least half their time reading mammograms. At the very least, seek out an enthusiast who goes to meetings and perhaps writes about mammography. (They show up on the Internet.)

Look for clinics where two doctors independently interpret every film.

Ask about "medical audits," which show if a doctor sends too many women for biopsies.

Use open-records laws to obtain a clinic's inspection reports, which list violations and chart the image-quality test known as the "phantom." Look for a combined score of 12 or more. Beware of citations for equipment failures or missing "QC," or quality control records.

 
DON'T'S

Don't press for an instant interpretation of your films. A day's delay through "batch" reading can maximize a doctor's power of concentration.

Don't put too much faith in a doctor being board certified in radiology. Many doctors passed before the late 1980's, when mammography was added to the exam. In any case, the number of practice mammograms it now includes do not reflect the rigors of real-world screening.

Don't judge doctors by the lawsuits they have lost for misreading mammograms. Even the best doctors will miss some cancers.

Don't put too much faith in promising but still unproven technologies like digital X-ray machinery and computer programs that look for cancers doctors might miss.

Don't have your mammogram done on Mother's Day, when many clinics offer free or discounted exams. These programs can swamp the doctors and rush the reading.

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