Objective: Some authors have proposed a national mammography registry to improve and monitor breast diagnostic practices. However, issues such as confidentiality, accuracy, and direct and indirect costs are practical barriers to implementing such a registry. This paper describes the development and design of a population-based mammography registry in New Hampshire. The project's objectives are to assess the accuracy of mammography by comparing interpretive results with pathology and tumor-registry reports and to improve mammographic performance by reporting findings to facilities, radiologists, and pathologists statewide.
Materials and methods: We recruited radiologists and pathologists through professional associations and facilities through site visits. Data used to develop and design the registry were collected during site visits, using structured face-to-face interview methods. Only one site refused to provide site-specific information.
Results: Facilities in New Hampshire estimated the annual mammographic volume to be approximately 148,000. We have noted a great deal of variability in mammography practices. Their principal methods for determining screening versus diagnostic mammograms were by patient self-reports (44% of practices), referring physicians' reports (38%), and radiologists' reports (18%). Although 71% of practices have computers, only 16% have radiology information systems or hospital information systems that offer computerized patient-tracking capabilities. More than 90% of New Hampshire radiologists exclusively use freehand dictation for reporting, and although almost 50% codify reports, only 11% use the American College of Radiology lexicon. These data and concerns expressed by radiologists, pathologists, technologists, and administrators helped shape the New Hampshire registry.
Conclusion: Heterogeneity of radiologic practices poses major challenges for implementing a population-based mammography registry. Issues such as confidentiality, the difficulty of assessing diagnostic acumen, and the time involved in providing data to a registry must be adequately addressed. For the registry to succeed in such diverse settings, researchers, radiologists, pathologists, technologists, and administrative staff must collaborate and cooperate.