Canadian Mammography Quality Guidelines

1. Introduction

Breast cancer is the most frequently diagnosed cancer among Canadian women and the second leading cause of cancer death. In 1988, the National Workshop on the Early Detection of Breast Cancer made the recommendation that mammography be encouraged and offered to women aged 50 to 69 on a biennial basis. Today mammography screening programmes have been established across most Canadian provinces and territories and the number of mammograms performed yearly has increased substantially.

Mammography is currently the most accurate diagnostic modality available for the detection of breast cancer. However, in order to have an effective mammography service, it is essential that mammography be performed to meet rigorous quality requirements. A good mammography programme is one that provides the highest quality diagnostic information at the lowest radiation risk to the patient, but quality must always take precedence over radiation dose. The responsibility for the quality of mammography in Canada is shared among federal, provincial and territorial governments, and the medical professionals who carry out the procedure and interpret the films.

The purpose of this document is to provide guidance to all mammography facilities, both screening and diagnostic, to ensure mammography of the highest quality. It specifies personnel, equipment and quality assurance standards necessary to achieve and maintain a good quality film-screen mammography service. The contents of this document are built upon and harmonized with existing Canadian standards pertaining to mammography. This includes the Diagnostic X-ray Equipment Regulations, Part XII, of the Radiation Emitting Devices Act, which regulates the construction and functioning of mammographic X-ray equipment, the requirements of the Mammography Accreditation Program of the Canadian Association of Radiologists, provincial requirements, and Safety Code 33 which addresses radiation protection in mammography. It should be noted that other provincial or territorial requirements may exist that supersede or add to provisions of this document. This document does not apply to digital mammography systems.

In a field in which technology is advancing rapidly and where unexpected and unique problems continually develop, this document cannot cover all possible situations. Blind adherence to rules cannot substitute for the exercise of sound judgement. Recommendations may be modified in unusual circumstances, but only upon the advice of experts with recognized competence in radiation protection and in the operation of mammographic X-ray equipment. This document will be reviewed and revised periodically and a particular requirement may be reconsidered at any time if it becomes necessary to cover an unforeseen situation. Interpretation or elaboration on any point can be obtained by contacting the Consumer and Clinical Radiation Protection Bureau, Health Canada, Ottawa, Ontario, K1A 1C1.