by
Christina Hwang, Contributing Reporter | July 04, 2016
From the July 2016 issue of HealthCare Business News magazine
“With 2-D mammography, approximately 10 percent of women are recalled from screening, which results in lots of extra tests and anxiety for patients,” says Dr. Liane Philpotts, chief of breast imaging at Yale-New Haven Hospital. “With 3-D mammography, those false positives are reduced by 30 to 40 percent. You [can] see many benign things with tomosynthesis that you weren’t seeing before, such as cysts or benign masses, and you have to learn how to disregard many of them. You have to learn how to let some things go, but also train your eyes to notice subtle malignant masses.”
Although Philpotts says scrolling through all of the images that are part of a tomosynthesis exam can be tiring and requires a certain learning curve, she believes that anyone who starts using tomosynthesis prefers it.
Drawbacks of tomosynthesis
Though physicians have lauded the benefits that 3-D mammography brings to the field, there are some disadvantages that can be found in this screening method. The studies being conducted mainly focus on the sensitivity of the test for breast cancer screening. Jonas Rehn, senior product manager of mammography solutions and global diagnostic X-ray at Philips Healthcare, believes that the reason 2-D is still preferred over 3-D in current screening programs lies with the limitations of studies being conducted.
“There are no studies to date on the impact of tomosynthesis on mortality. The studies that are available focus on surrogate endpoints such as cancer detection rates and in very few cases interval cancer detection rates,” he says. Up until last year, there was no code for tomosynthesis, so there was no reimbursement.
It was in January 2015 when a code for tomosynthesis became available for reimbursement at approximately $57, although the range can be from $25 to $125, depending on specific hospitals. CMS does cover the cost, but many private insurers do not. ECRI’s Roth credits this to a mixed pot of evidence — some showing tomosynthesis increases the recall rate, some showing that it decreases the recall rate and others showing that tomosynthesis does nothing at all.
Yale-New Haven’s Philpotts thinks that there are more than enough studies consistently showing positive results in terms of increased cancer detection and reduced recalls for private companies to reimburse. “[Private insurers] are still trying to hold out and say that it’s ‘experimental’ and ‘investigational,’” she says, “and this is troubling since there are five years or more of data that are consistently showing positive results. I think it’s only a matter of time before they’re forced to pay. While the equipment is more costly, even with the added cost of $57 to a mammogram, it will still save money. Ultimately, down the line, [tomosynthesis] saves money in terms of reduced recalls, fewer diagnostic exams and fewer biopsies.”
