Dr. Elizabeth A. Morris
Q&A with Dr Elizabeth A. Morris, President of the Society of Breast Imaging
July 06, 2015
by Lauren Dubinsky, Senior Reporter
HealthCare Business News spoke with Dr. Elizabeth A. Morris, president of the Society of Breast Imaging, about her experience with tomosynthesis and what direction she thinks the technology is headed in.
HCBN: How do you think the health care industry as a whole feels about tomosynthesis? Are they more excited or more uncertain about it?
EAM: I think they are excited. The preliminary studies that have come out have clearly shown that it overall increases cancer detection and decreases recall rates. There is a learning curve for radiologists associated with implementing tomosynthesis, but it appears that there is a great benefit to women. Critics of screening mammography are saying that mammography does not pick up enough cancers and it causes too much harm by having patients recalled for additional views. Tomosynthesis is able to address these specific criticisms of screening digital mammography.
HCBN: As a physician, what has been your experience with tomosynthesis?
EAM: I get a much better view of what is in the breast than with a full-field digital mammogram. I would much rather read a tomosynthesis exam, because I have increased confidence that I have evaluated all of a patient’s breast and that if there is a cancer hiding in dense breast tissue I will have a better chance of seeing it.
HCBN: Does the technology have a learning curve?
EAM: Breast Imagers are required to go through a training program in order to understand how to interpret the images and recognize potential artifacts. Tomosynthesis is basically seeing the same information as on a mammogram but in greater detail. I feel very comfortable reading a tomosynthesis exam as I’m seeing a much more detailed view of the breast.
It does take me a lot longer to look at a tomosynthesis examination because there are more images — with a standard mammogram you’re only looking at four images but with tomosynthesis you are multiplying that by at least 10, if not 20 times, depending on the thickness of the imaging slice.
HCBN: CMS is now providing reimbursement for tomosynthesis, which was a huge hurdle, but are there any hurdles still in the way of widespread adoption?
EAM: I would say that there is little resistance to widespread adoption other than the fact that it takes a long time for people to convert their existing base of mammographic units over to units capable of tomosynthesis. It’s expensive, so people are not going to do that overnight; it’s going to be a process.
HCBN: The USPSTF believes there is insufficient evidence to use tomosynthesis as a screening modality for breast cancer. What are your thoughts about that?
EAM: The JAMA trial had over 400,000 women and was a multi-center trial that showed an increased cancer detection rate and a decreased recall rate. It’s a definitive trial in my view. Additionally, it is only one of hundreds of trials that have been performed in many different countries most of which support the use of tomosynthesis. The ACR and SBI do not agree with the Task Force that there is insufficient evidence. The radiologists who perform breast imaging have quickly grasped its potential and the installed base of tomosynthesis units is increasing dramatically. I think that the Task Force is in the very, very small minority of people who think there is currently not enough evidence.
HCBN: Do you think tomosynthesis will replace 2-D mammography as a screening tool in the near future?
EAM: I see tomosynthesis eventually replacing 2-D mammography. But first of all there has to be access, which means that centers have to convert over to tomosynthesis. In addition, there has to be reimbursement for it. I personally think that there is enough evidence from the trials already to show that it’s superior over full-field digital mammography and I think most people in breast imaging feel that way. There is this feeling that maybe we need a big, randomized, controlled trial. I personally think that it would be unwise to put off a decision to embrace tomosynthesis before the results of such a trial as it will be expensive and we may have to wait a long time for results. The whole field is moving toward tomosynthesis, not only in the U.S. but in Europe as well. We need to figure out better ways to validate new technology rather than mount these types of trials.
HCBN: How do you think the health care industry as a whole feels about tomosynthesis? Are they more excited or more uncertain about it?
EAM: I think they are excited. The preliminary studies that have come out have clearly shown that it overall increases cancer detection and decreases recall rates. There is a learning curve for radiologists associated with implementing tomosynthesis, but it appears that there is a great benefit to women. Critics of screening mammography are saying that mammography does not pick up enough cancers and it causes too much harm by having patients recalled for additional views. Tomosynthesis is able to address these specific criticisms of screening digital mammography.
HCBN: As a physician, what has been your experience with tomosynthesis?
EAM: I get a much better view of what is in the breast than with a full-field digital mammogram. I would much rather read a tomosynthesis exam, because I have increased confidence that I have evaluated all of a patient’s breast and that if there is a cancer hiding in dense breast tissue I will have a better chance of seeing it.
HCBN: Does the technology have a learning curve?
EAM: Breast Imagers are required to go through a training program in order to understand how to interpret the images and recognize potential artifacts. Tomosynthesis is basically seeing the same information as on a mammogram but in greater detail. I feel very comfortable reading a tomosynthesis exam as I’m seeing a much more detailed view of the breast.
It does take me a lot longer to look at a tomosynthesis examination because there are more images — with a standard mammogram you’re only looking at four images but with tomosynthesis you are multiplying that by at least 10, if not 20 times, depending on the thickness of the imaging slice.
HCBN: CMS is now providing reimbursement for tomosynthesis, which was a huge hurdle, but are there any hurdles still in the way of widespread adoption?
EAM: I would say that there is little resistance to widespread adoption other than the fact that it takes a long time for people to convert their existing base of mammographic units over to units capable of tomosynthesis. It’s expensive, so people are not going to do that overnight; it’s going to be a process.
HCBN: The USPSTF believes there is insufficient evidence to use tomosynthesis as a screening modality for breast cancer. What are your thoughts about that?
EAM: The JAMA trial had over 400,000 women and was a multi-center trial that showed an increased cancer detection rate and a decreased recall rate. It’s a definitive trial in my view. Additionally, it is only one of hundreds of trials that have been performed in many different countries most of which support the use of tomosynthesis. The ACR and SBI do not agree with the Task Force that there is insufficient evidence. The radiologists who perform breast imaging have quickly grasped its potential and the installed base of tomosynthesis units is increasing dramatically. I think that the Task Force is in the very, very small minority of people who think there is currently not enough evidence.
HCBN: Do you think tomosynthesis will replace 2-D mammography as a screening tool in the near future?
EAM: I see tomosynthesis eventually replacing 2-D mammography. But first of all there has to be access, which means that centers have to convert over to tomosynthesis. In addition, there has to be reimbursement for it. I personally think that there is enough evidence from the trials already to show that it’s superior over full-field digital mammography and I think most people in breast imaging feel that way. There is this feeling that maybe we need a big, randomized, controlled trial. I personally think that it would be unwise to put off a decision to embrace tomosynthesis before the results of such a trial as it will be expensive and we may have to wait a long time for results. The whole field is moving toward tomosynthesis, not only in the U.S. but in Europe as well. We need to figure out better ways to validate new technology rather than mount these types of trials.