Current issues surrounding research of the efficacy and utilization of mammography in women aged 40-49 are presented in the broader context of the psychosocial, economic, and information needs and dynamics that can affect consumer decision-making and access to mammography. Specific recommendations are made concerning the need for new approaches to research in detection methods. The relevance of federal regulatory developments in quality control to questions of outcomes and efficacy generally, and particularly in the 40-49 age group, is discussed. Opportunities created by new Public Health Service initiatives to increase access to mammography by improving utilization, professional education, and quality of care, thus developing meaningful outcome data, are highlighted.