Though the population of women over 40 is on the rise, the number of mammography facilities fully certified in compliance with the provisions of the Mammography Quality Standards Act (MQSA) has declined slightly over the past five years. In December 2002, there were 9,306 fully certified facilities; as of December 31, 2007, there were 8,859. Facilities may be closing their doors because of profitability issues, but the dip could also be accounted for by practices that realize that full-field digital mammography (FFDM) allows them to accommodate higher screening volumes within a single facility. Adoption of FFDM has been rapid over the past two years, according to data from the MQSA National Statistical Archive kept by the Food and Drug Administration. In May 2008, there were 3,121 facilities with FFDM in the United States, up from 1,795 in May 2007 and from just 977 in May 2006. Other MQSA data show that the number of mammograms performed annually in the United States has climbed steadily over the past five years, despite facility closures. In 2007, 35.5 million procedures were reported, compared with 33.8 million in 2005 and 31 million in 2003. Recent trends, however, show a decline in the percentage of women over 40 undergoing mammographic screening. A 2007 study by Breen et al1 found that screening rates dropped from 70% in 2000 to 66% in 2005. Data from a more recent study by Rao et al2 showed that although the screening rate among the female Medicare population over 40 increased 166% between 2000 and 2005, the 2005 rate (at 39,363 mammograms per 100,000 female Medicare beneficiaries) is well below the level that would indicate that the mammography recommendations of the American Cancer Society were being followed. The authors suggested a number of possible causes, including declines in the number of screening facilities and in the number of radiologists who read mammograms. The MQSA data show a clear progression toward fewer facility violations at levels 1, 2, and 3; this is evidence that the MQSA has had a positive effect on quality assurance in mammography operations. In December 2002, the National Statistical Archive reveals, 9.1% of facilities had level-3 violations, 24.7% had level-2 violations, and 2% had level-1 violations. By April 2008, the percentage of facilities with violations had dropped dramatically: 6.1% had level-3 violations, 16.1% had level-2 violations, and 1.3% had level-1 violations.