According to the American Cancer Society (ACS), most doctors feel that early detection tests for breast cancer can save thousands of lives every year. Most of the practices rely on screening to find cancer before the patients start to show symptoms. Several billable screening techniques used for women include mammograms, clinical breast exam, breast-self exam and even MRI screening. However, a new screening study from Lund University, Sweden has revealed that digital breast tomosynthesis (DBT) can detect 40% more breast cancers than traditional mammography. Researchers claim this as the first large-scale study to compare the screening method with regular mammograms.
A total of 7500 women in the age group 40 to 74 participated in the study and underwent one-view DBT and two-view digital mammography (DM), with independent double reading and scoring. The primary outcome measures were detection rate, recall rate and positive predictive value. It was found that 68 women from the total number of participants were identified with breast cancer. When 46 cases were detected by both DBT and DM, 21 were detected by DBT alone and one by DM alone. One-view DBT increased the cancer detection rate significantly with 8.9/1000 screens compared to 6.3/1000 screens for two-view DM. The recall rate also increased significantly with DBT, but was still low. Overall, using one-view DBT as a standalone modality for breast cancer screening was found to be feasible.
Breast tomosynthesis is a three-dimensional X-ray technique that works on the same principle as tomography. With this technique, X-ray images of the breast can be acquired from different angles so as to show multiple thin layers of the breast. This makes it easier to detect tumors in the breast tissue. DBT also reduces discomfort and pain since there is no need to compress the breast firmly as in the current examination technique. The other advantages include lower radiation dose than in traditional mammography and easy availability of the equipment on the market.
It is expected that all of these advantages with DBT would increase the participation in future screening programs. This study supports the transition to the new technique. The concerns related to DBT coding are not very significant now, as four new procedure codes exist to report tomosynthesis. The 2015 CPT manual introduced three new procedure codes and the Centers for Medicare & Medicaid Services (CMS) created a new G code for tomosynthesis for use as of January 1, 2015. They are:
- 77061: Digital breast tomosynthesis; unilateral
- 77062: Digital breast tomosynthesis; bilateral
- 77063: Screening digital breast tomosynthesis, bilateral (list separately in addition to code for primary procedure)
- G0279: Diagnostic digital breast tomosynthesis, unilateral or bilateral
However, there is a risk of overdiagnosis with this new technique as with other screening methods. An increase in recall rates means more healthy women are recalled for further testing, which may cause unnecessary psychological stress. Practices must take account of these challenges very carefully while implementing this method on a large scale.