Mammography Quality Standards Act

October 1, 2013 | Healthcare Risk, Quality, & Safety Guidance


While the implementation of MQSA has brought uniformity to performing mammograms, defined education and training requirements for staff, and mandated reporting of results to patients, malpractice cases involving a missed diagnosis of breast cancer remain prevalent. A review of 623 office-based malpractice cases between 1997 and 2006 found that 324 cases (52%) involved an allegation of diagnostic error (LaValley). Of these diagnosis-related cases, 17 were associated with missed breast cancer diagnosis, resulting in more than $10 million in incurred losses (LaValley).

A 1990 study conducted by the Physician Insurers Association of America found that delay in the diagnosis of breast cancer was the second most common reason that physicians were sued for malpractice. Follow-up studies in 1995 and 2002 found that a delay in breast cancer diagnosis had become the most common reason for a malpractice lawsuit. In the 2002 study, interpreting radiologists were the most commonly named defendants. Payments related to breast cancer were second only to payments for cases involving neurologically impaired newborns, and the average payment for breast cancer cases in the 2002 study was $438,047. (Dick et al.)

The Physician Insurers Association of America reported that breast cancer was the most common condition for which radiologists were sued from 1985 through 2008. Claims resulted in an indemnity payment almost 40% of the time for breast cancer claims from 1985 through 2008. The total indemnity paid for these claims was nearly 34% of the total paid for all radiology claims. (Kessler and Jones)

Nevertheless, a review of the history of ACR-accredited mammography facilities indicates that overall, the quality of mammography facilities has improved. In 1995, the first-attempt pass rate for accreditation was 73%. But beginning in 1996, when the majority of mammography facilities had become accredited and certified under MQSA, the first-attempt pass rate increased overall, and 88% of units successfully completed the accreditation process on the first attempt in 2003. Comparatively, only 70% of mammography units applying for accreditation passed between 1987 and 1991, when the program was still voluntary. Of the 609 units that failed the first attempt at accreditation between 1987 and 1991, 88% passed on their second attempt, for a total of 88% of facilities passing on their first or second attempts. Of the 610 units that did not pass in 2003, 89% passed on their second attempts, for a total overall pass rate of 98%. (Destouet et al.)

In 1994, when the MQSA program was in its second year, renewing facilities had a passing rate of 88%, compared with 70% for those undergoing initial accreditation, supporting ACR’s conclusion that MQSA has improved mammography quality. Another indication of quality improvement is the number of scheduled on-site surveys that ACR has had to conduct at facilities after three unsuccessful attempts at accreditation. In 1996, when the policy was initiated, ACR made 32 surveys. While the number has fluctuated since then, only six on-site surveys were conducted in 2003. (Destouet...

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