Strategies for implementation and quality assurance for mammographic screening.

Compliance with screening mammography guidelines is affected by complex factors, including cost, accessibility, education, and attitudes of referring physicians. High-volume mammography facilities have lower fees and higher quality. Quality assurance is the focus of the voluntary American College of Radiology Mammography Accreditation Program, and over half of all mammography units are accredited. Nonetheless, pressure for mandatory quality standards is increasing. Mobile mammography reduces costs and increases access, but it presents challenges in financing and quality assurance. These screening issues, especially quality assurance, are not taught adequately in radiology residency training programs. Yet public awareness of the benefits of early detection has resulted in more lawsuits for failure to diagnose and delay in diagnosis. Preventive measures reduce medicolegal risks. On a personal level, the psychologic trauma of screening mammography is greater than was previously suspected. However, associated anxiety and stress do not seem to affect compliance with screening guidelines adversely.