From the July 2015 issue of HealthCare Business News magazine

Traditional 2-D mammography has long been the gold standard for breast cancer screening but tomosynthesis has been gaining interest ever since the first commercial system received FDA approval in 2011. Most physicians are excited about this new technology’s potential to reduce recall rates and detect more invasive cancers, but the U.S. Preventive Services Task Force still views it as investigational.

The drawbacks of 2-D mammography are that breast cancers can be missed because they are hidden behind normal breast tissues, and normal breast tissues can superimpose on one another and create “summation shadows” that appear to be cancer but are not, says Dr. Daniel Kopans, professor in the department of radiology at Harvard Medical School, director of breast imaging at Massachusetts General Hospital, and widely considered to be the “father of breast tomosynthesis.”

“Reading a 2-D mammogram is like holding a book with clear pages up to the light — you can see the words, but they are superimposed on one another making it difficult to read,” wrote Kopans. “[Tomosynthesis] allows you to read each page individually.”
The University of Pittsburgh was one of the early adopters of tomosynthesis in 2006 for research, and it is also one of the first that implemented it in the screening setting in 2012. Dr. Margarita Zuley, professor of radiology at the university, is hopeful that tomosynthesis will impact interval cancer rates and mitigate some of the harms of 2-D mammography including false positives.

But despite those benefits, a few challenges remain in the way of widespread adoption. CMS is now providing coverage for the procedure, but many private insurers have not followed suit and there is not yet a standard approach to acquiring an image.

The reimbursement puzzle
Nov. 5, 2014, marked a major achievement for tomosynthesis when CMS announced that it would reimburse an average of $50 per exam. But a 2-D mammography exam is still required prior to the tomosynthesis exam. Hospital administrators are satisfied with the rate of Medicare reimbursement, but radiologists do not share that sentiment, says Jennifer Okken, women’s health product manager at Siemens Healthcare. Since tomosynthesis takes three times as long for them to read compared to 2-D mammography, they believe that reimbursement should be higher.

Most private payors are not completely on board with reimbursement yet. A few small and local private insurers are providing coverage, but no large private payors have joined them. “Patients are very confused by it because most insurance carriers are not covering it currently,” says Zuley. “Facilities are stuck either eating the cost of this new technology or charging patients directly, neither of which is an optimal solution.”

July 2015 Magazine

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