The medical audit of technical and interpretive aspects of mammography has been recommended by a number of expert panels and as part of some regulations that govern the oversight of mammography. The value of the medical audit is to aid practitioners in the performance evaluation of mammography in their facilities. Collection and analysis of audit data at a regional or national level have the potential to allow for the comparison of practice-level performance with regional and national-level performance and to provide a public health tool for the evaluation and improvement of breast cancer detection. In addition, a regional and national-level breast cancer database has the potential for allowing monitoring and tracking of women participating in a screening program. Prior to establishing such a database, data must be protected from discovery and disclosure, and patient and physician confidentiality must be ensured.