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    termine whether they adequately cover the total costs of providing the procedure. The cost analysis of mammography should include the costs associated with meeting the requirements of the Mammography Quality Standards Act. A panel of external and independent experts should be involved in the analysis.

    7. The Health Resources and Services Administration (HRSA) should undertake or fund a study that analyzes trends in specialty training for breast cancer screening among radiologists and radiologic technologists and that examines the factors that affect practitioners' decisions to enter or remain in the field. If the trend suggests an impending shortage of trained experts, HRSA should seek input from professional societies such as the American College of Radiology and the Society of Breast Imaging in making recommendations to reverse the trend.

    8. Until health insurance becomes more universally available, the U.S. Congress should expand the Centers for Disease Control and Prevention screening program to reach a much larger fraction of eligible women, and state legislatures should participate in the federal Breast and Cervical Treatment Act by providing funds for cancer treatment for eligible women. The Centers for Disease Control and Prevention should be expected to reach 70 percent of eligible women (as opposed to the current 15 percent). This objective is based on the stated goals of the U.S. Department of Health and Human Services' Healthy People 2010 report, which by the year 2010 expects 70 percent of women over age 40 to have had a recent (within the last 2 years) screening mammogram.

    9. The National Cancer Institute should sponsor large randomized trials every 10 to 15 years to reassess the effects of accepted screening modalities on clinical outcome. These trials would compare two currently used technologies that are known to have different sensitivities. Breast cancer-specific mortality would be the principal outcome under evaluation. Such studies are needed because detection technologies and treatments are both continually evolving. Hence, the benefit of a screening method may change over time.

    10. The National Cancer Institute, through the American College of Radiology Imaging Network or the Breast Cancer Surveillance Consortium, should sponsor further studies to define more accurately the benefits and risks of screening mammography in women over age 70. As the age distribution of the U.S. population continues to shift toward older ages, the question of whether these women benefit from screening mammography will become increasingly important.

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