Last Tuesday was a great day for Delaware women. To improve access for Delaware state employees to the best evidence-based diagnostic tool for women’s breast health, the State Office of Management and Budget voted to provide 3D mammography to employees and dependents in the state’s health plan as a benefit with zero copay.
This important decision speaks to the value and cost-effectiveness of offering the highest quality care.
Research conducted at Christiana Care Health System and other major U.S. and international institutions demonstrate that 3D mammography, also known as tomosynthesis, is a game-changer in women’s health. It enables more accurate diagnosis and can eliminate unnecessary tests and the anxiety that accompanies them.
Traditional 2D mammography performed without the 3D component has been the standard for many years, but is less precise and leads to more second mammograms and other tests to rule out cancer.
Adding 3D mammography often decreases the need for these additional tests. Any woman will tell you that uncertain mammogram results can be upsetting, if not terrifying—just imagine being notified of the need to come back in for more testing and additional waiting. The need for further testing also means increased costs.
Adding 3D mammography provides a much more detailed view inside the breast. It captures images at multiple angles during a short scan, producing 3D images. The images enable doctors to view the breast one millimeter at a time, seeing detail inside the breast in a way never before possible. It significantly improves the ability of doctors to obtain all the information they need to make an accurate diagnosis. The result is a more cost-effective process that improves the detection of cancer.
In a study published in 2017 in Radiology, one of the most widely recognized, peer-reviewed medical journals, my fellow researchers and I showed that adding 3D mammography decreased the callback or “recall” rate for a second mammogram because of a potential irregularity seen on the first mammogram by 50 percent. Our false positive rate also decreased by over 50 percent.
3D mammography has also decreased our biopsy rate by more than 35 percent. In fact, this successful technology has not only reduced the quantifiable costs of unnecessary additional testing, procedures and additional radiation, it also has decreased the unquantifiable costs of anxiety, work absence, lost productivity, child care costs and additional medical appointments.
Based on a commitment and the proven value to women’s health, Christiana Care invested in 3D mammography and the expert staff to implement it. Also supporting the cause with generous donations was Delaware philanthropist and businesswoman Tatiana Copeland.
Christiana Care was one of the first facilities in the United States to offer 3D mammography. From a patient’s perspective, nothing on the surface has changed, but the technology has the potential to be life-changing for all women.
3D mammography is one of the few areas in medicine that is a true win-win. There are few health care technologies that demonstrate such an increase in both sensitivity and specificity. With 3D mammography, we have both increased our ability to identify more invasive, deadly cancers earlier and increased our ability to screen all women with more accuracy.
While new technology may raise concerns about cost and effectiveness, in the case of 3D mammography one need only look at the body of literature and the results of published, comprehensive peer-reviewed research here in Delaware and around the world to allay any doubts.
Rather than drive up costs, the technology saves real dollars with real improvements to quality of care. In our study of 78,810 mammograms, 1,420 women did not need a recall after their 3D mammogram. Upon further analysis, this translated into a potential cost savings of over $2.3 million.
As a physician, I am excited by the value that the progress in medicine, technology and legislative awareness has brought to women’s breast health. Six states have instituted insurance mandates to cover 3D mammography, including our neighbors in Pennsylvania and Maryland.
With zero-copay access to the gold standard of 3D mammography, Delaware is proving itself a leader in preventive care, health care cost savings, and value—for state employees and the families and friends who love and depend on them.
I am hopeful that this is the beginning of access to 3D mammography with no financial barriers for all women in Delaware.
Jacqueline S. Holt, M.D., FACR, is director of Breast Imaging at the Helen F. Graham Cancer Center & Research Institute at Christiana Care Health System.