It’s well known that using additional screening modalities beyond traditional 2D mammography can detect more cancers in women with dense breast tissue. But at what cost? A new study in Clinical Breast Cancer documents both the clinical value and the economic cost of supplemental breast imaging technologies.
2D mammography is the basis for any breast cancer screening program, but the modality’s shortcomings are well known, especially in women with dense breasts.
- In fact, the FDA earlier this month began requiring breast imaging providers to notify women of their density status and explain how higher density is a breast cancer risk factor.
Imaging vendors and clinicians have developed a range of technologies to supplement 2D mammography when needed, ranging from DBT to molecular breast imaging to breast MRI.
- Each has its own advantages and disadvantages, which can leave many breast imaging providers confused about the best technology to use.
To shed some light, Matthew Covington, MD, of the University of Utah compared detection rates for various supplemental imaging modalities; he then estimated costs for each if it was the only modality used for supplemental imaging with 2D mammography in a U.S. population with 469k detectable breast cancers.
- The study assumed that 2D mammography would detect only 41% of cancers – leaving the majority undetected.
Adding a supplemental modality boosted cancer detection rates, but also screening’s cost …
- DBT detected 47% of all cancers at a cost of $933M
- Ultrasound detected 51% at a cost of $1.84B
- MBI detected 71% at a cost of $4.16B
- Contrast-enhanced mammography detected 80% at a cost of $3.87B
- MRI detected 100% at a cost of $6.36B
As the data indicate, MRI is clearly the most effective supplemental modality, but at a cost that’s almost 7X that of DBT.
The Takeaway
The new data are a fascinating – if sobering – look at the intersection of clinical value and economic cost. They also highlight healthcare’s inconvenient truth: The resources needed to provide the highest-quality care are finite, regardless of whether you’re in a single-payor or fee-for-service system.
