Patients less likely to use DBT screening mammography due to financial responsibility

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 - DBT
Mediolateral oblique images in 61-year-old woman with 12-mm invasive lobular carcinoma in the right breast. Left: FFDM image. Middle: Current synthesized 2D image. Right: DBT image.
Source: Radiology: http://dx.doi.org/10.1148/radiol.13131391

Patients are less likely to choose digital breast tomosynthesis screening mammography (DBTSM), despite more accurate results than traditional 2D mammography screening (2DSM), because of potential financial considerations, according to a new study published in the Journal of the American College of Radiology.

“This is the first project to assess whether a patient’s financial responsibility affects her decision to undergo DBTSM,” wrote the researchers, led by Emily Sedgwick, MD, an associate professor of breast imaging at the Lester and Sue Smith Breast Center.

Researchers from Baylor College of Medicine offered patients the option of receiving 2DSM coupled with DBTSM or only 2DSM at the time of scheduling appointments, at check-in and before the examination. The staff was educated on tomosynthesis and the risk and benefits associated with both types of imaging. Possible copayment of DBTSM was also discussed.

Researchers reviewed 9,503 screening mammography patients conducted over an 18-month period. There were 5,079 DBTSM patients and 4,424 2DSM patients. Relating to financial responsibility, there was a statistically significant difference between women who chose DBTSM and those who chose 2DSM.

“We found that patients who had any out-of-pocket expenses at the time of their mammographic studies were significantly less likely to undergo DBTSM than women who had health plans that completely covered the cost of DBTSM," they wrote.

The researchers sought to justify DBSTM use by evaluating the outcomes of the patients in the review.

The DBTSM group:

  • Had a recall rate of 4.4 percent.
  • Had a cancer detection rate of 4.9/1000 patients.
  • Had a positive predictive value of 9.5 percent.
  • Found 16 invasive cancers in patients.

The 2DSM group:

  • Had a recall rate of 5.4 percent.
  • Had a cancer detection rate of 3.6/1000 patients.
  • Had a positive predictive value of 6.7 percent.
  • Found 8 invasive cancers in patients.

The researchers noted the reduction in recall rate with the use of DBTSM in the 2DSM patient population would have resulted in 197 fewer patients being called back, producing a savings of $28,565. Those same patients may have avoided unnecessary anxiety because of the recall.

“DBTSM has been shown to reduce unnecessary additional imaging and unnecessary biopsies and to detect additional cancers,” the authors wrote. “On the basis of our correlation of a patient’s out-of-pocket expense and underutilization of DBTSM, health care providers should advocate that 100 percent coverage for DBTSM also be mandated.”