Mammography is an important tool for detecting breast cancer at an early stage. When coupled with appropriate treatment, early detection can reduce breast cancer mortality. At the request of Congress, the Food and Drug Administration (FDA) commissioned a study to examine the current practice of mammography and breast cancer detection, with a focus on the FDA's oversight via the Mammography Quality Standards Act (MQSA), to identify areas in need of improvement. Enacted in 1993, MQSA provides a general framework for ensuring national quality standards in facilities performing screening mammography, requires that each mammography facility be accredited and certified, and mandates that facilities will undergo annual inspections. This book recommends strategies for achieving continued progress in assuring mammography quality, including changes to MQSA regulation, as well as approaches that do not fall within the purview of MQSA. Specifically, this book provides recommendations aimed at improving mammography interpretation; revising MQSA regulations, inspections, and enforcement; ensuring an adequate workforce for breast cancer screening and diagnosis; and improving breast imaging quality beyond mammography.

In 2002, Lippincott published the Manual of Breast Diseases, edited by Professor Ismail Jatoi. The current book, Management of Breast Diseases, is an adaptation of that manual, with Professor Manfred Kaufmann of the Goethe-University of Frankfurt serving as co-editor. Most of the chapters from the original manual have been either extensively revised or discarded, and several new chapters added. This text contains more material than the original manual, but it is still intended as a basic guide for the wide spectrum of clinicians (surgeons, gynecologists, oncologists, radiation onco- gists, internists, general practitioners) who treat breast diseases, both benign and malignant. To compile this text, we assembled experts from throughout the world. Thus, this text provides not only a broad overview of breast diseases, but also highlights diff- ent perspectives from different parts of the world. Yet, it is worth noting that the management of breast cancer is now largely predicated on evidence-based medicine. Several large, randomized prospective trials have demonstrated the ef? cacy of breast cancer screening and chemoprevention. Other large trials have addressed the impact of systemic therapy, radiotherapy, and variations in local therapy on breast cancer mortality. Many of these landmark trials are discussed in this text, and they clearly have had a bene? cial effect. Indeed, since about 1990, breast cancer mortality rates have declined substantially in most industrialized countries, and this trend is expected to continue in the years ahead.

Though overall cancer incidence and mortality have continued to decline in recent years, cancer continues to devastate the lives of far too many Americans. In 2009 alone, 1.5 million American men, women, and children were diagnosed with cancer, and 562,000 died from the disease. There is a growing body of evidence linking environmental exposures to cancer. The Pres. Cancer Panel dedicated its 2008¿2009 activities to examining the impact of environmental factors on cancer risk. The Panel considered industrial, occupational, and agricultural exposures as well as exposures related to medical practice, military activities, modern lifestyles, and natural sources. This report presents the Panel¿s recommend. to mitigate or eliminate these barriers. Illus.