Supplemental screening for women with dense breasts is proven to find more cancers but is it economically sustainable? A new study in Italy led by Dr. Gianfranco Scaperrotta, Head of the Breast Imaging Unit of the Foundation IRCCS National Cancer Institute of Milan, says yes.
“Adding hand-held breast ultrasound to mammography is a method that has already proven to be able to double the detection rate in breast screening, but there are concerns about false positives, user variability and unsustainable costs. Therefore, starting from these considerations, we decided to approach these concerns with a lean and fast system like Automated Breast Ultrasound (ABUS), which offers high diagnostic sensitivity, reproducible and far less operator variability,” said Dr. Scaperrotta.
Mammography continues to serve as the first line of defense for breast cancer screening worldwide. However, tumors are more difficult to detect in women with dense breasts due to what is known as the ‘masking effect’, where both dense tissue and cancer appear white on a mammogram. In this patient population that is already at higher risk for breast cancer, the decrease in mammography’s effectiveness can lead to delayed diagnosis and higher mortality.
“Approximately 40% of European women have dense breasts,” said Dr. Scaperrotta. “A multimodality screening strategy allows us to compensate for the limitations of current breast screening practices, particularly for these women with dense breasts.”
The study analyzed the Italian NHS perspective and healthcare expenditure over three years.
The model looked at three breast screening pathways, considering both the screening and diagnosis phase and the cancer care and treatment phase of the breast care pathway:
- Using mammography alone
- Using both associated mammography and traditional hand-held ultrasound for dense breasts
- Using a path combining mammography and ABUS for dense breasts
Researchers from the Foundation IRCCS National Cancer Institute of Milan used Invenia ABUS to conduct the economic study. The study found that beyond the proven clinical outcomes of adding ABUS to mammography, a there were also economic benefits, with savings of over 50 million Euros for the Italian National Health Service when compared to using mammography screening only. A prior research study has shown a 57% increase in invasive cancer detection rate when Invenia ABUS was added to mammography by keeping a stable recall rate of 2.3 %.
The study found that the addition of ABUS initially led to an increase in system expenditures in the screening phase, however, the economic savings were realized in the later phases for patients undergoing treatment for breast cancer.
“The result obtained is very interesting because it shows that if ABUS detects small invasive early-stage cancers while also having lower and sustainable costs compared to traditional hand-held ultrasound, it allows a strong repercussion on the costs of medical treatment, particularly surgical, with significant economic savings for the Italian NHS, especially for the first year of diagnosis,” Dr. Scaperrotta said.
Moving forward, this study in Italy is hoping to provide a model for the future of personalized breast care with important clinical and economic outcomes.
“This study shows that automated breast ultrasound is an effective, integrative approach to breast screening providing both clinical and economic value,” said Dr. Scaperrotta. “These findings can help us better serve both our patient population and our health system through a more personalized and effective approach to breast care.”
 Article access on 7/15/2020: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5872003/
 Article accessed on 7/15/2020: https://www.sciencedirect.com/science/article/pii/S0720048X16301760