Also, glowing reports of “medical breakthroughs” and “promising” technologies that have not been submitted for approval or even tested in patients add another layer of confusion and uncertainty.

Physicians face different kinds of decisions. When confronted with an abnormal mammogram, they must decide which technology will provide the most expedient and reliable result and, then, how much faith to put in that result. At present, they receive little research-based guidance about emerging technologies, which combinations of technologies, and which approaches would be most effective for certain groups of patients.

The committee included clinicians involved in breast cancer screening, detection, and treatment; experts in cancer and molecular biology; those with expertise in clinical studies, as well as those involved with the development, evaluation, and adoption of medical technology and with experience in health care administration.

To supplement their own considerable expertise, members held a number of background workshops and heard from a range of technology developers, researchers, and leaders of clinical studies designed to improve systems for early detection and diagnosis. They also discussed the many issues involved in assessing new medical technologies with senior staff at the federal agencies and with representatives of private insurance groups, all the groups that act as gatekeepers for medical technology.

Based on this information and their lengthy deliberations, the committee identified four major categories for recommendations aimed at improving early detection and diagnosis of breast cancer: improve current application of screening mammography; integrate biology, technology, and risk models to develop new screening strategies; improve the environment for research and development; and improve the implementation and use of new technologies. The detailed rationale and supporting data for each category are in the body of the report. A brief summary of pertinent findings, together with the recommendations, follows (recommendations are also listed separately in the box at the end of this summary).

IMPROVE CURRENT APPLICATION OF SCREENING MAMMOGRAPHY

A growing shortage of radiologists who specialize in reading mammograms, coupled with an imbalance between the closures and openings of screening facilities, has created unacceptable delays in some parts of the country. At the same time the number of false-positive readings appears to be increasing, possibly due to increasing defensive medicine in reaction to the frequency of malpractice litigation.

Improving screening practices to reduce the number of false positives could reduce the costs of additional testing by an estimated $100 million



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