Page 5 - Focus March 2018

| The Christiana Care Way
3-D mammography demonstrates the link between innovation and value
by Jacqueline S. Holt, M.D., FACR, Director of Breast Imaging at the Helen F. Graham Cancer Center & Research Institute
Our mission, The Christiana Care Way, is to “create innovative, effective, affordable systems of care that our neighbors value.”
Achieving value for patients is the overarching goal of health care. That last word — value — is vital. Value means making a measurable difference in people’s lives through what we do, in ways that people appreciate and that they and our society can afford.
Innovation in health care in itself can be exciting. But unless innovation is tied to value, we cannot achieve our health care goals.
As stewards of our society’s precious health care resources, we strive to invest in innovations that will lead to greater value for the community we serve — and to forego innovations that won’t.
Research conducted at Christiana Care and other major U.S. and international institutions demonstrates that 3D mammography, also known as tomosynthesis, is a game-changer in value for 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 the journal Radiology, 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.
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, childcare costs and additional medical appointments.
Based on its 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. Today, this technology is also available at many of our Imaging Services locations.
3D mammography is one of the few areas in medicine that is a true win-win. Few health care technologies demonstrate such an increase in both sensitivity and specificity. We have increased our ability to identify more invasive, deadly cancers earlier and increased our ability to screen all women with more accuracy.
The technology also 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.
Recently the Delaware 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. Today, more women in our state have access to 3D mammography with no financial barriers.
I am hopeful that this is the beginning of access to 3D mammography with no financial barriers for all women in Delaware. This technology is a shining example of the important relationship between innovation and value in delivering high- quality, affordable care to everyone we serve. n
A version of this article appeared in The News Journal in February.
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