BERKELThe Agency for Health Care Policy and Research (AHCPR) was LIBestablished in December 1989 under Public Law 101-239 (Omnibus UNIV Budget Reconciliation Act of 1989) to enhance the quality, CALIAPPROpriateness, and effectiveness of health care services and access to these services. AHCPR carries out its mission by conducting and supporting general health services research, including medical effectiveness research, facilitating development of clinical practice guidelines, and disseminating research findings and guidelines to health care providers, policymakers, and the public. The legislation also established within AHCPR the Office of the Forum for Quality and Effectiveness in Health Care (the Forum). The Forum has primary responsibility for facilitating the development, periodic review, and updating of clinical practice guidelines. The guidelines will assist practitioners in the prevention, diagnosis, treatment, and management of clinical conditions. Other AHCPR components include the following. The Center for practitioners, the scientific community, educators, and consumers. Number 13 Quality Determinants Quality Determinants of Mammography Guideline Panel Lawrence W. Bassett, MD (Co-chair) R. Edward Hendrick, PhD (Co-chair) Priscilla F. Butler, MS Marydale DeBor, JD Carl J. D'Orsi, MD Carol J. Garlinghouse, MSN, RNC Richard F. Jones III, MD J. Leonard Lichtenfeld, MD Lynda N. Reynolds, BS, RT U.S. Department of Health and Human Services Public Health Service Agency for Health Care Policy and Research AHCPR Publication No. 95-0632 Guideline Development and Use Guidelines are systematically developed statements to assist practitioner and patient decisions about appropriate health care. This guideline was developed by an independent multidisciplinary panel of private-sector clinicians and other experts convened by the Agency for Health Care Policy and Research (AHCPR). The panel employed explicit, science-based methods and expert clinical judgment to develop specific statements on quality determinants of mammography. Extensive literature searches were conducted and critical reviews and syntheses were used to evaluate empirical evidence and significant outcomes. Peer review and field review were undertaken to evaluate the validity, reliability, and utility of the guideline in clinical practice. The panel's recommendations are primarily based on the published scientific literature. When the scientific literature was incomplete or inconsistent in a particular area, the recommendations reflect the professional judgment of panel members and consultants. The guideline reflects the state of knowledge, current at the time of publication. Given the inevitable changes in the state of scientific information and technology, periodic review, updating, and revision will be done. We believe that the AHCPR-assisted clinical guidelines will make positive contributions to the quality of care in the United States. We encourage practitioners and patients to use the information provided in this Clinical Practice Guideline. The recommendations may not be appropriate for use in all circumstances. Decisions to adopt any particular recommendation must be made by the practitioner in light of available resources and circumstances presented by individual patients. Clifton R. Gaus, ScD Agency for Health Care Policy and Research Publication of this guideline does not necessarily For sale by the U.S. Government Printing Office Superintendent of Documents, Mail Stop: SSOP, Washington, DC 20402-9328 Foreword A 3 C55 Mammography is the primary tool for the early detection of breast cancer. An estimated 23.5 million mammograms were performed in 1992 PUBL at a cost of about $2.5 billion. Based on current trends, 1 woman in 8 will have breast cancer during her lifetime and 1 in 33 will die from breast cancer. The probability of developing breast cancer increases with age. Mammography is the only detection technique shown to reduce breast cancer mortality, particularly in older women. The purpose of this guideline is to improve the quality and delivery of mammography. Several health professionals are involved in referring women for mammography and in providing mammography services, including the referring health care provider, the interpreting physician, the radiologic technologist, and the medical physicist. Similarly, several steps are involved, including referring the woman for mammography, performing the mammography, and communicating results in a timely manner. The task of the panel was to consider the many links in the chain of events that comprise mammography, identify where problems exist, and define a guideline statement to ensure quality and eliminate identified problems. The Quality Determinants of Mammography Guideline Panel is composed of experts from a broad range of medical disciplines, as well as consumer representatives knowledgeable about mammography. The guideline development process began with a detailed identification of important questions concerning mammography. Based on these questions, the scientific literature was searched thoroughly. Panel members and consultants to the panel then identified and reviewed the relevant literature, evaluating it for scientific validity. Guideline statements were developed based on scientific evidence (which varied in quality and quantity depending on the topic) and on the basis of panel expert opinion. The guideline underwent peer review by experts in the public and private sectors. 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