Summary of PAHO's expert consultation held Oct 27-29, 2015
Breast cancer is the most common cancer among women in Latin America and the Caribbean (LAC). Screening and early detection, linked to timely and appropriate treatment, is critical to reduce breast cancer mortality. Mammography plays a critical role, but to ensure its effectiveness and patient safety, stringent quality assurance is required. This includes high quality equipment, sufficient skilled professionals, and image quality control. In limited resource settings, however, assuring quality of mammography services can be challenging.
The Pan American Health Organization convened an expert consultation on mammography quality standards, with representatives from 10 countries in Latin America and the Caribbean and 3 professional associations. The consultation was to discuss the challenges with mammography quality and begin to develop baseline standards for mammography quality assurance, which is feasible and relevant for the context of Latin America and the Caribbean.
The expert group reviewed the situation and challenges of mammography and assuring quality in each country. It was noted that this region has made some significant advances in expanding mammography services and access to mammography screening and diagnosis. Yet, the expert consultation noted that there is a tremendous need to put in place regulations and procedures to assure high quality mammography services for all women.
During the meeting, the director of the WHO Collaborating Centre for Breast Diagnostic Imaging in Mammary Pathology, Dr Gustavo Mysler, highlighted the significant factors to ensure high quality mammography services. These factors include technology (the right equipment), correct use and maintenance of the technology, and correct imaging for the ability to accurately identify cancer.
Regarding the technology, it was noted in the meeting that the distribution of mammography equipment is not always well balanced within the country. Some regions have the right number of mammography equipment for the population served, while others have high numbers of mammography equipment concentrated in only a few centers, without equitable access to mammography. Many countries have introduced mobile mammography units to reach a greater proportion of their population, but it was noted that these units are often poorly maintained and without adequate quality control procedures.
The correct use and maintenance of the mammography equipment was also discussed during the meeting. "Performing a mammography is not only about clicking a button to take a picture", said Kayiba Medlen, from the PAHO/WHO Radiological Health Program. "There are many other factors and skills involved in ensuring a high quality image, so that it can then be sent to the radiologist for a correct interpretation". Many participants noted the challenges with assuring quality images, including adequate training of radiology technologists, as well as the high costs of maintenance for mammography equipment.
Correct interpretation by the radiologist of the mammography image is an important step to guarantee an accurate diagnosis. In this meeting, however, it was noted that in some mammography services, the quality of interpretation, measured by the diagnostic agreement between radiologists, was sub-optimal. The need for continuing education in mammography and reinforcement of skills was highlighted.
Regarding mammography quality assurance procedures, the experts reached an agreement on several key points that will be essential to achieve a significant improvement in the quality of mammography services in Latin American and the Caribbean. In this regard, an outline for a mammography quality assurance guide was developed. The guide will provide direction on all aspects of quality assurance, including training and competencies of mammography personnel, equipment maintenance and quality checks, among other items. A small working group was formed by PAHO, with some of the experts attending the meeting to continue to develop and finalize the mammography quality guide. The guide is expected to be available later in 2016, to then be applied in mammography services throughout the region.