Imaging programs transition to digital mammography
Technology too expensive for some
While results from the Digital Mammographic Imaging Screening Trial (DMIST) trial, published in 2005, demonstrated that digital mammography outperformed conventional film-screen mammography for a large percentage of women,1 data from the Food and Drug Administration (FDA) show that the technology has only been adopted by 34% of the 8,853 imaging sites in the United States.2
The reason for this hesitation is simple, according to Antonio Garcia, an imaging industry analyst based in the San Antonio, TX office of Frost & Sullivan, a multinational business consulting firm. "There is a big price differential between full-field digital mammography [FFDM] and film- screen mammography," he says. "On average, it is two to three times as expensive to purchase a FFDM system as opposed to a film-screen system." And when you add to that price differential the fact that most imaging sites operate under a very slim profit margin, Garcia stresses that many sites are simply not in a position to invest that much money on a FFDM system.
Despite the harsh economic realities, however, the ability to offer digital mammography is becoming a competitive advantage as consumers read and hear more about the advantages of the technology, reported as a result of the DMIST trial. In that study, involving a database of nearly 50,000 women, investigators concluded that digital mammography is more accurate in women under the age of 50, women with radiographically dense breasts, and women who are premenopausal or perimenopausal.1
Steve Votey, RT(R)(CT), manager of diagnostic imaging at Blue Hill (ME) Memorial Hospital, says, "In those groups of women, [digital mammography] was able to detect 29% more cancers than traditional film-screen mammography." Votey also points out that about 65% of all participants in the study were in one of the three groups that benefit from digital mammography. "There is a large number of women who will benefit from this, and for all of the other women, the study showed that [digital mammography] was at least equal to film-screen mammography," he says.
Since publication of the DMIST trial results, Votey has noticed a steady increase in the number of women asking when Blue Hill is going to go digital. "Women are very well informed about health care and especially about mammography," he says. And Votey believes that transitioning to FFDM — which Blue Hill is doing now — will enable the imaging program to significantly increase its mammography business. "We had a survey done, and we were not realizing about one-third of the patients in our service area. We were getting about 66%," he says. However, given that the hospital's two competitors in the area do not have FFDM capabilities, Votey believes that Blue Hill will be able to bump that percentage up to 80% within two years.
Interestingly, the decision to go digital was an easy sell to hospital administrators, according to Votey, because they saw that there were clinical benefits to the technology. Also, they liked the idea of linking the project to a community fundraising campaign, he says. "We have had some very good interest in it by benefactors who have been willing to donate significant sums of money to help us get going on this," Votey says. Consequently, while reimbursement rates are the same for conventional and digital mammography, Blue Hill will not have to pass along any rate increases to patients.
What about newer technologies?
While the market penetration for digital mammography is relatively modest, it is apparent that a growing number of imaging programs are coming to the same conclusions as Blue Hill. Over the last two years, growth in the adoption of digital mammography has averaged about 60%, Garcia says, "and for the next eight years, we are expecting a growth rate of 25% [per year] on average." At that rate, every mammography facility in the United States would have at least one digital mammography unit by the year 2013.
However, with the advent of newer technologies such as digital breast tomosynthesis (DBT), will FFDM be outdated by that time? The future is difficult to predict, but Garcia points out that government regulators have a strong record of moving slowly and carefully in this field. "The FDA is very cautious about any types of radiological devices that are used with breast imaging," he says. "Breast imaging is one of the most highly regulated procedures in all of medical imaging and probably all of medicine."
Nonetheless, to ease concerns that imaging programs may have about investing in FFDM as newer technologies become available, the large makers of FFDM units, including General Electric, Siemens, and Hologic, are offering buyers credits or other incentives to smooth their transition to DBT, when it is approved.
Votey, who is purchasing FFDM units manufactured by Hologic, indicates that he has been given that assurance. "We are a small hospital, so when a technology first comes out, it is out of our range in terms of being able to afford it," he says. "But as time goes by, I suspect that we will probably upgrade to [DBT] somewhere down the road. And with what we are buying now, there is an upgrade path."
References
- Pisano E, Gatsonis C, Hendrick E, et al. Diagnostic performance of digital versus film mammography for breast-cancer screening. New Eng J Med 2005; 353:1,773-1,783.
- US Food and Drug Administration. National statistics as of April 1, 2008, from the Mammography Quality Standards Act (MQSA) Score Card. Accessed at www.fda.gov.
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