Mammography screening and the self-referred woman.

There are no easy answers to the question of whether a mammography screening practice should accept self-referred women. The major reason for doing so is the fact that many women are not being screened either because their primary care physicians do not initiate mammography screening referrals or because they do not have a physician at all. However, this compelling argument is at least partially countered by the numerous problems encountered when practices accept self-referred women, including potential adverse medicolegal consequences, tedious and time-consuming reporting requirements, the possibility of turf battles with referring physicians, and, especially if breast physical examination is not offered, somewhat increased costs of screening. The ultimate decision of whether self-referred women are accepted will probably be based on an analysis of the prevailing conditions in each radiologist's local environment. Because local conditions vary greatly, so may the final decision vary. However, once the choice is made, steps should be taken to provide ready access to screening while also reducing the frequency with which self-referral-related problems occur. To this end, those radiologists who decide to accept self-referred women, particularly if screening is done with mammography alone, should attempt to convert as many self-referred cases as possible into patient-initiated physician referrals. Similarly, radiologists who decide to screen on a referral-only basis should develop mechanisms that make it very easy for self-referred women to obtain physician referrals.