by
Lisa Chamoff, Contributing Reporter | July 24, 2017
From the July 2017 issue of HealthCare Business News magazine
Advancing tomo adoption as 2-D slows
Proponents of digital breast tomosynthesis point to how it leads to decreased recall rates and false positives – benefits that yield more efficient care delivery and a better patient experience. Dr. David Gruen, director of women's imaging and co-director of the Breast Center at Stamford Health in Stamford, Conn., calls digital breast tomosynthesis the “modern-day holy grail of screening.”
Before screening with tomosynthesis, most radiologists were recalling 10 to 20 percent of their screening patients. In Gruen's practice, adopting tomosynthesis almost instantaneously decreased recalls by 45 percent, he says, while the cancer detection rate increased from 4 to 5.6 per 1,000 women, and the cancers that were detected, on average, were smaller.
“I think the slower adoption is almost completely driven by payers,” Gruen says. “People don’t want to invest in technology when they’re not going to get paid.”
In addition to reimbursement concerns, tomosynthesis exposes patients to a higher dose of radiation than 2-D mammography on its own. For radiologists, it also takes longer to read since there are 60 to 80 images for each exam.
Since there are fewer false positives, Gruen says the decrease in unnecessary callbacks opens up time to look at the tomosynthesis images and dedicate more time to care for the women who have real abnormalities.
Agnes Berzsenyi, president and chief executive officer of women’s health for GE Healthcare, says 26 percent of radiologists have adopted digital breast tomosynthesis. While Medicare and a few private insurance companies cover the exam, and three states — Illinois, New York and Pennsylvania — require coverage for tomosynthesis, data show that only 35 to 40 percent of women eligible for screening have coverage for tomosynthesis.
“Minimizing the economic barriers is going to be key in driving adoption,” Berzsenyi says.
The U.S. market for 2-D mammography is down about 10 percent due to the adoption of digital breast tomosynthesis, which is up about 13 percent, according to Berzsenyi. “This gap will continue to grow given the benefits of DBT, changing reimbursement, education and continued technology innovation,” she predicts.
