CMS should remember the meaning of those pink ribbons

This October, as many put on pink t-shirts for awareness and raise money for breast cancer prevention, detection and treatment, the Centers for Medicare and Medicaid Services (CMS) has the opportunity to make a decision that would enhance women’s chances for early detection of breast cancer and less invasive treatment options.

CMS is poised to release the final rule on its coding guidelines and payment rates at the end of October. Unfortunately, the breast cancer advocacy community and doctors like myself are growing increasingly concerned that CMS will continue its current policy of not providing any additional reimbursement for 3D mammograms. This will depress any incentives for breast cancer screening centers to invest in this proven superior technology. And the impact will go beyond Medicare beneficiaries, as we know the nation’s health insurers look to CMS for guidance in developing their own reimbursement guidelines. Bottom line: the failure by CMS to recognize the added costs of 3D mammograms will hurt women’s access to the best technology available.

{mosads}A recent study published in the Journal of the American Medical Association (JAMA) demonstrated that 3D mammography addresses the two most common shortcomings of traditional mammography screening – false-positive findings and over-diagnosis. These are true limitations. In a recent article in the Journal of Women’s Health, “Understanding Patient Options, Utilization Patterns and Burdens Associated with Breast Cancer Screening,” the authors explored the confusion women face in making informed decisions about breast cancer screening due to a lack of consensus among organizations developing screening guidelines and the mixed messages they deliver. This is a situation that the upcoming CMS decision will only exacerbate if it does not provide appropriate reimbursement for 3D mammograms.

Advances like 3D mammography vastly improve doctors’ ability to distinguish between inconsequential findings and serious cancers. This leads to fewer false positive recalls from screening exams, lessens the need for additional imaging studies and reduces unnecessary biopsies. Women also benefit from a reduction in anxiety caused by the uncertainty and stress of additional diagnostic tests that may result in normal findings.

Additionally, by improving doctors’ ability to make the right diagnosis on the first visit, 3D mammograms reduce the number of women lost to follow up—those women who never come back when their doctors need to take another look at their breasts. This problem is particularly acute among low income and minority women, no doubt because the burden of out of pocket costs and time lost to follow up visits (including days off work) can be so high. Ultimately, fewer recalls will reduce the financial burden for both the individual patient and the health care system, and studies show 3D mammography can reduce that recall rate by up to 40 percent.

The JAMA study showed 3D mammography finds significantly more invasive, or lethal, cancers than a traditional mammogram. This 41 percent increase in invasive cancer detection also contributes to a better peace of mind for women—they can feel more confident that their annual mammogram will not miss an early stage cancer—and it further reduces costs as earlier stage cancers are easier and less expensive to treat and, even more importantly, have a much higher survival rate.

Ensuring all women have access to 3D mammography is one way our health care system can support a more thoughtful approach to breast cancer screening that takes into account the tangible and intangible costs that women bear when it comes to screening. This Breast Cancer Awareness Month, I have one request: that CMS set an appropriate payment rate for 3D mammography, one which recognizes the individual and systemic benefits of the most important advance in breast cancer screening in decades.

Hampton is a breast surgeon and the co-founder and medical director for the Breast Care of Washington — a community-centered breast cancer screening organization founded to enhance access to breast cancer screening and care among medically underserved women in the Washington, D.C. area.