- What is a mammogram?
- What’s the difference between a screening mammogram and a diagnostic mammogram?
- How is a mammogram done?
- What to expect when you have a mammogram
- Where can I get help with mammogram costs?
- How is mammography regulated?
- What does the doctor look for on a mammogram?
- What if a breast biopsy is needed?
- Understanding your mammogram report – BI-RADS categories
- What are the limitations of mammograms?
- Mammograms in special circumstances
- Newer techniques for improving mammograms
- When are other breast imaging tests used?
- Experimental and other breast imaging methods
- To learn more
How is mammography regulated?
In the United States, mammography is highly regulated. Although the overall quality of mammography has improved since its introduction in the late 1960s, studies done in the mid-1980s showed that quality varied greatly from place to place.
To help educate those working with mammograms, improve quality, and lower the dose of radiation, the American Cancer Society asked the American College of Radiology (ACR) to establish standards and criteria that would help women and doctors find those facilities that provided high-quality screening services. In 1986, the ACR started the first national Mammography Accreditation Program (MAP). This voluntary program raised standards nationwide and led to better mammogram services at those sites that took part in the program.
In 1992, Congress passed the Mammography Quality Standards Act (MQSA) to ensure that radiology facilities offering mammography would be required to meet minimum quality standards. Today, the US Food and Drug Administration (FDA) certifies every facility offering mammography (except those of the Department of Veterans Affairs). In order to be certified, the equipment, personnel, and practice of the facility must be reviewed by an FDA-approved accreditation body, have an on-site inspection, and meet the following criteria:
- Each mammography unit has to be accredited.
- Certain staff members must meet strict standards including:
- Typical x-rays are reviewed for quality and information on radiation dose, which is required to be very low.
- Radiologists (the doctors who interpret or read the mammograms)
- Radiologic technologists (those who actually position women for the mammogram and take the pictures)
- Medical physicists (professionals who specialize in medical equipment and image production)
If the facility meets all of the required standards, the FDA gives its certification. These standards are outlined in the MQSA, which has been in effect since 1994. It is unlawful to do mammograms in the United States without an FDA certificate.
The FDA has a list of all of its certified mammography facilities by state and zip code. You can find those near you by visiting the FDA’s website: www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfMQSA/mqsa.cfm.
Mammogram clinics must notify women in writing about the results of their mammograms. The Mammography Quality Standards Act (MQSA) requires this. Mammography clinics still report mammogram results to the woman’s doctor, too, who is responsible for ordering more tests or treatments, if needed.
The MQSA requires clinics to mail women a separate, easy-to-understand summary of their mammogram results within 30 days—or “as quickly as possible” if the results suggest cancer is present. This means that the woman may know about the results before her doctor calls to tell her. If the woman wants the full written mammography report, she’ll need to ask for it in addition to the summary.
Radiation exposure from mammography
The modern mammography machine uses low radiation doses to produce breast x-rays that are high in image quality. (It usually uses about 0.1 to 0.2 rads per picture; a rad is a measure of radiation dose). Older mammography units delivered higher doses, and led to concerns about radiation risks. These older machines are no longer used.
Strict guidelines ensure that mammography equipment is safe and uses the lowest dose of radiation possible. Many people are concerned about the exposure to x-rays, but the level of radiation from a mammogram today does not significantly increase the breast cancer risk for a woman who gets regular mammograms.
To put dose into perspective, if a woman with breast cancer is treated with radiation, she will likely get a total of several thousand rads. If she has yearly mammograms starting at age 40 and continues until she is 90, she will get a total of 20 to 40 rads. To put it another way, the dose of radiation that she gets during one screening mammogram is about the same amount of radiation she would average from her natural surroundings (background radiation) over a couple of months.
Mammograms require very small doses of radiation. The risk of harm from this radiation is extremely low, but in theory, repeated x-rays might have the potential to cause cancer. Still, the benefits of mammography outweigh any possible harm from the radiation exposure.
Women should always let their health care providers and x-ray technologists know if there is any chance that they are pregnant. Although the risk to the fetus is likely to be low, mammograms done for screening aren’t done in pregnant women.
Last Medical Review: 12/10/2013
Last Revised: 11/05/2014