Ever since digital breast tomosynthesis (DBT) was introduced, it has been met with myriad questions inquiring about its effectiveness. A recent study out of the Perelman School of Medicine at the University of Pennsylvania published in JAMA Oncology may have put some of those questions to bed.

“Earlier research on 3-D mammography did evaluate screening outcomes beyond the first year or perhaps 18 months of using the new technology,” Dr. Emily F. Conant, the study’s senior author and chief of breast imaging in the department of radiology at the Perelman School of Medicine, told HCB News. “Our study is the first to show at the site level that even at three years out, the improved outcomes remain.”

Conant and her research team evaluated 44,468 screening mammography exams performed at the Perelman Center for Advanced Medicine — 23,958 of which had no history or clinical history of breast cancer. All of the screenings took place between September 2010 and August 2011 and the women only received 2-D digital mammography.
But when the hospital purchased Hologic’s Genius 3D MAMMOGRAPHY system, all of the women then began to undergo both 2-D digital mammography and DBT of each breast from October 2011 to September 2014.

They found that initial DBT screening led to fewer patients called back for sometimes unnecessary imaging, more cancer cases found in recalled patients and fewer breast cancers diagnosed between regularly scheduled appointments in women who received a healthy negative reading. The results were published in JAMA Oncology.

But the problem is that most private payors are not completely on board with reimbursement yet. CMS announced on November 5, 2014 that it would reimburse an average of $50 per exam, but only a few small and local private insurers are providing coverage.

“These results are important to policy makers deciding whether or not to reimburse for 3-D mammography,” said Conant. “This data supports that indeed, 3-D mammography is the ‘better mammogram.’”

DBT will eventually become the standard screening tool for breast cancer, but reimbursement is what is currently standing in its way, according to Conant.

“Right now, at many sites, women have to pay extra for a 3-D mammogram because their insurance will not pay the extra fee,” she said. “Hopefully, our study and other data that will emerge over time will support that 3-D mammography improves the risk-benefit ratio in breast cancers screening.”

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