THE NEW-HAMPSHIRE MAMMOGRAPHY NETWORK - THE DEVELOPMENT AND DESIGN OFA POPULATION-BASED REGISTRY

OBJECTIVE. Some authors have proposed a national mammography registry to improve and monitor breast diagnostic practices. However, issues su ch as confidentiality, accuracy, and direct and indirect costs are pra ctical 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 tu mor-registry reports and to improve mammographic performance by report ing findings to facilities, radiologists, and pathologists statewide. MATERIALS AND METHODS. We recruited radiologists and pathologists thro ugh professional associations and facilities through site visits. Data used to develop and design the registry were collected during site vi sits, using structured face-to-face interview methods. Only one site r efused to provide site-specific information. RESULTS. Facilities in Ne w Hampshire estimated the annual mammographic volume to be approximate ly 148,000. We have noted a great deal of variability in mammography p ractices. Their principal methods for determining screening versus dia gnostic mammograms were by patient self-reports (44% of practices), re ferring physicians' reports (38%), and radiologists' reports (18%). Al though 71% of practices have computers, only 16% have radiology inform ation systems or hospital information systems that offer computerized patient-tracking capabilities. More than 90% of New Hampshire radiolog ists exclusively use freehand dictation for reporting, and although al most 50% codify reports, only 11% use the American College of Radiolog y lexicon, These data and concerns expressed by radiologists, patholog ists, technologists, and administrators helped shape the New Hampshire registry. CONCLUSION. Heterogeneity of radiologic practices poses maj or challenges for implementing a population-based mammography registry . Issues such as confidentiality, the difficulty of assessing diagnost ic acumen, and the time involved in providing data to a registry must be adequately addressed, For the registry to succeed in such diverse s ettings, researchers, radiologists, pathologists, technologists, and a dministrative staff must collaborate and cooperate.