Breast cancer is the most common cancer among women. Despite increasing incident rates, annual mortality rates have declined by approximately 2% per year, which has been attributed to the combination of earlier detection and improvements in treatments.
Mammography plays a key role in early breast cancer detection. Two-dimensional digital mammography is the current standard of care in breast cancer screening. An abnormal finding with screening mammography prompts additional imaging with diagnostic mammography, targeted breast ultrasound or breast magnetic resonance imaging. These additional studies may determine the need for a breast biopsy in order to determine if the area of concern is benign or malignant. A considerable percentage of women to be called back for additional imaging or biopsy do not ultimately have cancer (i.e. a false positive test result) resulting in unnecessary patient anxiety and economic burden.
Three-dimensional mammography, or digital breast tomosynthesis (DBT), is a technological advancement over two-dimensional mammography. Digital breast tomosynthesis reduces challenges due to overlapping structures in breast tissue associated with two-dimensional mammography. Publications of breast cancer screenings performed using DBT have demonstrated reduction in recall between 15% and 37% and an accompanying increase in invasive cancer detection of 10% – 54%.
It is still not clear whether those screens, which can cost significantly more than traditional two dimensional digital mammograms, are worth the money. To that end, the ClinocoEconomics and Outcomes Research Journal, published by Dove Research, set up an economical model to evaluate the impact and value of DBT, comparing two screening mammography scenarios for all women in a hypothetical US managed care plan. The first plan used two-dimensional full field digital mammography (FFDM) alone and the second used FFDM combined with DBT.
The annual costs of mammography screening in the US is approximately 8 billion every year. Using a hypothetical reimbursement for $50 for DBT, the hypothetical costs savings amount to 2.4 million dollars across the million member health plan.
Average annual per patient cost saving due to the use of DBT are $28.53. If you factor in the reduced number of false positives, those numbers can climb as high as $52.64 per patient.
The study concluded that the use of DBT as a mammography screening substantially reduces the need for follow-up diagnostic services and improves detection of invasive cancers, allowing for earlier, less costly treatment. These benefits could translate into meaning costs savings for US commercial health insurers and their patients.
With approximately one in seven women receiving additional diagnostic imaging following digital screening mammography at an average cost of over $1,200, and with the costs of breast cancer ranging with increasing stage from $35,000 to $224,000, wider adoption of DBT mammography presents a significant opportunity to deliver value based care in the US health system.
Diagnostic Imaging Services performs 3D mammograms at our Women’s & Advanced Imaging Center in Metairie.
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