Mammography outcomes analysis: potential panacea or Pandora's box?

As a consequence of the demand for and perceived value of mammography outcomes analysis, collection of community-based mammography data by the NHMN and others has begun and is supported by the radiologists involved. Radiologists are increasing their use of standardized coding of report data necessary for clear communication and data collection but remain justifiably concerned about the confidentiality of these data. If stronger protection of these data is forthcoming, more radiologists will be encouraged to perform practice audits. The pooling of community-based data as exemplified by NHMN will create statistics that measure the actual practice of mammography and estimate its impact on breast cancer. For individual radiologists, the audit process will improve their mammography skills through direct feedback of results and provide important information about their patterns of interpretation. Although this approach will create community standards, comparisons with such standards may be more applicable among various communities than among individual radiologists because of the statistical variation created by the relatively small numbers of cancers found by individual radiologists, the differences in populations served by these radiologists, and the variability in reproducing the audit by individuals or groups. Pooled community data, however, will still be useful to community radiologists as general standards toward which to strive. We believe that medical audits offer important potential public health benefits for breast cancer control. Insofar as confidentiality issues cannot be effectively addressed by individual radiologists, institutions in a position to be advocates should immediately explore how legal underpinnings can be put in place to protect the audit process from disclosure. With such protection, the audit process may fulfill its potential for the radiologist's pivotal role in breast cancer control; without it, the process may prove to be a Pandora's box for the community radiologist.