Why do some patients decline DBT for breast cancer screening?

Breast cancer screening using digital breast tomosynthesis has risen rapidly in the United States, but that isn’t the case in all regions or across all institutions, according to a new study published in Current Problems in Diagnostic Radiology.

“Despite the advantages of reduced callback rates, higher sensitivity, and higher specificity associated with digital breast tomosynthesis (DBT) over traditional full-field digital mammography (FFDM), many patients declined DBT at our urban academic breast center,” wrote Kellie Chiu, with University of Maryland Medical Center’s Department of Diagnostic Radiology and Nuclear Medicine, and colleagues.

According to the researchers, using DBT to screen patients could lead to about $2.4 million per year in cost savings per one million patients. Overall research on the challenges of adopting DBT is “lacking,” the group noted, particularly from the patient perspective.

With this in mind, Chiu et al. conducted an anonymous, nine-question patient survey at their breast center in Baltimore from February to April 2017. During that time, 867 patients underwent mammography screening and a total of 110 surveys were included in the study—a response rate of 21.69%.

The survey included an introduction on the potential benefits of DBT along with potential additional charges dependent on the patient’s insurance coverage. Respondents were asked to rank their reason for declining DBT; they were given the following options: cost, increased radiation risk, anxiety about new technology, exam discomfort, lack of DBT education, doubtful benefit without dense breast or family history. They rated their responses on a scale of 1-5, with 1 being “strongly disagree.”

Overall, the potential additional costs of DBT were cited as the highest influence on a patient’s decision to decline the exam; 82% of respondents said they “strongly agree” with cost concerns for an average score of 4.68 of 5. A majority (73%) of patients would consider DBT if there were no extra costs involved, the authors noted.

Importantly, this study was completed prior to Maryland’s enactment of a state mandate for insurance coverage of DBT. Chiu et al. predict an increase in screening DBT once the state mandate goes into effect.

Additional results are as follows:

  • 40% of patients chose DBT despite knowing an extra cost would follow, potentially showing there are other factors involved aside from money.
  • An increase in radiation dose did not cause much concern among those surveyed.
  • 9% of patients agreed or strongly agreed with the doubtful benefit of DBT for patients without dense breasts or high risk of cancer.

“Emphasis on the benefits for all patients despite breast density or family history may help patients accept DBT as a more valuable screening tool than FFDM,” the researchers concluded.