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Re-evaluate coverage policies for breast cancer


New NCCN guidelines include new technology as an option for patients’ annual screening.

New guidelines published by the National Comprehensive Cancer Network (NCCN) recommend that physicians consider 3-D mammography exams as an option for their patients’ annual breast cancer screening, including women of average risk age 40 and over.

This marks the first time that an independent authority of high-quality cancer care is formally recommending that this screening modality be considered for breast cancer screening.


“If you are a managed care plan, the July 2016 update to the NCCN guidelines for breast cancer screening means that plans may need to re-evaluate their current coverage policies for this technology,” says Managed Healthcare Executive editorial advisor Joel V. Brill, MD, chief medical officer, Predictive Health. 

“Digital breast tomosynthesis or 3-D mammography uses existing digital mammography equipment to obtain additional radiographic data that are used to reconstruct cross-sectional 'slices' of breast tissue,” Brill says. “Tomosynthesis, which involves additional imaging time and radiation exposure, hopes to improve the accuracy of digital mammography by reducing problems caused by overlapping tissue. The updated guidelines note that multiple studies show a combined use of digital mammography and tomosynthesis appears to improve cancer detection and decrease call-back rates, which are important considerations for organizations looking to deliver value-based, cost-efficient care to eligible populations.”

The majority of referring physicians and private insurance companies refer to the NCCN Guidelines frequently when making decisions on behalf of their patients, according to Pete Valenti, Hologic’s division president, breast and skeletal health solutions.

“With the NCCN statement that digital breast tomosynthesis should be considered in breast cancer screening guidelines, those providers can feel even more confident recommending it to their patients,” Valenti says. “Coverage for digital breast tomosynthesis will continue to increase as more and more physicians direct their patients to specifically request this as a screening option.”

According to Valenti, 3-D mammography exams reduce many of the costs typically associated with conventional digital mammography.

“They've also been showed to reduce callbacks and detect more invasive cancers earlier than conventional mammography, which as a result, reduces the need for unnecessary and costly follow-up exams and treatment and ultimately leads to improved outcomes.”  

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