Mammography Patient Lay Summary Letter (MQSA)

[Facility Name]
[Facility Address Line 1]
[Facility Address Line 2]
Phone: [Facility Phone Number]

[Patient Name]
[Patient Address Line 1]
[Patient Address Line 2]

[Date of Letter]

Subject: Your Mammogram Results

Dear [Patient Name],

Your Results

(Write at approximately 6th-grade reading level. Use second person, short sentences, and active voice. Select one key message below that matches the final signed radiology report. Include the exam type and date. If BI-RADS terms are included, define them in simple words.)

[Select ONE key message based on final assessment:]

• [Negative or Benign (BI-RADS 1 or 2): Your [exam type] on [exam date] did not show any signs of breast cancer. No areas of concern were seen.]
• [Incomplete (BI-RADS 0): Your [exam type] on [exam date] is not complete yet. We need more images and/or an ultrasound to look more closely.]
• [Probably Benign (BI-RADS 3): Your [exam type] on [exam date] showed a finding that is probably not cancer. We recommend a follow-up mammogram to be safe.]
• [Suspicious (BI-RADS 4 or 5): Your [exam type] on [exam date] showed an area that needs further testing. We recommend a biopsy to know for sure.]
• [Known Cancer (BI-RADS 6): Your [exam type] on [exam date] showed findings already known to be cancer from an earlier biopsy. Your care team will guide your next steps.]

Breast Density Information

(Select exactly one paragraph below. Do not modify this required language.)

[If breast tissue is NOT dense:]
Breast tissue can be either dense or not dense. Dense tissue makes it harder to find breast cancer on a mammogram and also raises the risk of developing breast cancer. Your breast tissue is not dense. Talk to your healthcare provider about breast density, risks for breast cancer, and your individual situation.

[If breast tissue IS dense:]
Breast tissue can be either dense or not dense. Dense tissue makes it harder to find breast cancer on a mammogram and also raises the risk of developing breast cancer. Your breast tissue is dense. In some people with dense tissue, other imaging tests in addition to a mammogram may help find cancers. Talk to your healthcare provider about breast density, risks for breast cancer, and your individual situation.

(If breast density classification is unavailable, obtain it before sending this letter.)

What You Should Do Next

(Include only actions from the signed radiology report. Provide specific timeframes and contact information. If laterality or location is unclear in the report, use general language.)

• [If routine screening: Return for your next screening mammogram in [timeframe], by [due date].]
• [If additional imaging needed: Call [Facility Phone Number] to schedule [additional imaging type] within [timeframe].]
• [If short-interval follow-up: Schedule a follow-up [exam type] in [timeframe], by [due date].]
• [If biopsy recommended: Contact [Healthcare Provider Name] or call [Facility Phone Number] to schedule a biopsy within [timeframe].]
• [If provider named: We sent a copy of your report to [Healthcare Provider Name].]

Important Reminder

If you notice a new lump, nipple discharge, skin changes, or other breast concerns, contact your healthcare provider—even if your mammogram was normal.

Contact Us

Call us at [Facility Phone Number]. Our hours are [Facility Hours].

[If applicable: You can view your results on our patient portal at [Portal URL].]

[If applicable: Interpreter services are available—please tell us your language when you call.]

Sincerely,

[Department Name]
[Facility Name]
Phone: [Facility Phone Number]