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3D mammography manufacturer’s release touts benefits that aren’t there

Reducing Recall Rate for Breast Cancer Screening Stands to Decrease Healthcare Costs and Increase Quality of Care for Women

MARLBOROUGH, Mass., April 26, 2016 /PRNewswire/ — Hologic, Inc. (Nasdaq: HOLX) announced that study results published today in a research letter in JAMA conclude that breast tomosynthesis (Hologic’s Genius™ 3D MAMMOGRAPHY™) exams reduce recall rates, and increase invasive cancer detection in women with both dense and nondense breasts. These key benefits of 3D MAMMOGRAPHY™ could lower the costs associated with needless follow-up exams, and improve patient experience for women seeking a more accurate screening mammogram.

Density is only identifiable on a mammogram or other imaging system, and is a reflection of how much fibrous or glandular tissue is in the breast. Higher breast density may increase a woman’s chance of getting breast cancer, make detection of cancer on conventional mammography more difficult, and increase the chances that a woman will be recalled for additional imaging.1,2 Mammograms are categorized into four density groups: almost entirely fat, scattered fibroglandular densities, heterogeneously dense, and extremely dense. The latter two groups are considered dense; however, the vast majority of women whose mammograms are considered dense have heterogeneously dense breast tissue.

“Density creates challenges for conventional mammography by obscuring the images, which often results in additional visits and exams for women,” said Edward Evantash, MD, board certified OB/GYN and Medical Director for Hologic. “This new analysis confirms that Genius™ 3D MAMMOGRAPHY™ exams reduce unnecessary follow-up exams in dense-breasted women. This has the potential to provide health systems and insurance companies with significant cost savings, reduce patient stress and expenses, and alleviate challenges for referring physicians who are tasked with relaying mammography results to their patients.”

Improvements in both recall rate reduction and invasive cancer detection were greatest for women with heterogeneously dense breasts, with a 50 percent increase in invasive cancer detection and a simultaneous 14 percent reduction in recall rate. Women with heterogeneously dense breasts make up about 40 percent of the U.S. screening population (women ages 40-74) — approximately 25 million women in the U.S.

“Utilizing Genius™ 3D MAMMOGRAPHY™ exams for breast cancer screening will reduce the need for subsequent unnecessary testing, and decrease the number of unnecessary breast biopsies— addressing concerns that were previously raised as limitations of conventional mammography while also reducing costs for health systems,” said Pete Valenti, Hologic’s Division President, Breast and Skeletal Health Solutions. “Twenty-six states have passed legislation requiring doctors to notify women if they have dense breasts — and now these women who were previously confused about how to proceed with breast cancer screening can feel confident turning to 3D MAMMOGRAPHY™ exams to reduce their chances of stressful recalls and help find more invasive cancer.”

This study brought together the principal investigators from the groundbreaking 2014 study on 3D MAMMOGRAPHY™ exams, also published in JAMA, this time led by Elizabeth Rafferty, MD, a co-author on the prior study.3 A total of 452,320 examinations (278,906 conventional mammograms compared to 173,414 Genius™ 3D MAMMOGRAPHY™ exams), were analyzed.

Genius™ 3D MAMMOGRAPHY™ exams have been available in the U.S. since 2011, and are only available on the Hologic Selenia® Dimensions® mammography system. In 2015 an estimated 10 million women in the U.S. benefited from a Genius™ exam. Additional information, as well as a locator to find imaging sites offering the exams, can be found at http://mygenius3d.com.

About Hologic
Hologic, Inc. is a leading developer, manufacturer and supplier of premium diagnostic products, medical imaging systems and surgical products. The Company’s core business units focus on diagnostics, breast health, GYN surgical and skeletal health. With a unified suite of technologies and a robust research and development program, Hologic is dedicated to The Science of Sure. For more information on Hologic, visit www.hologic.com.

Hologic, 3D, 3D Mammography, Dimensions, Genius, Selenia, and the Science of Sure are trademarks and/or registered trademarks of Hologic, Inc., and/or its subsidiaries in the United States and/or other countries.

Forward-Looking Statements
This news release may contain forward-looking information that involves risks and uncertainties, including statements about the use of Hologic mammography systems. There can be no assurance the systems will achieve the benefits described here, or that such benefits will be replicated in any particular manner with respect to an individual patient. The actual effect of the use of the systems can only be determined on a case-by-case basis depending on the particular circumstances and patient in question. In addition, there can be no assurance that the systems will achieve any expected level of sales or market share. Hologic expressly disclaims any obligation to release publicly any updates to the data or statements presented here to reflect any change in the Company’s expectations or any change in events, conditions or circumstances on which any such data or statements are based.

Media Contact:
Jane Mazur
508.263.8764 (direct)
585.355.5978 (mobile)
jane.mazur@hologic.com

Investor Contact:
Michael Watts
858.410.8588
michael.watts@hologic.com

 

1 Yaghjyan L, Colditz GA, Collins LC, et al. Mammographic breast density and subsequent risk of breast cancer in postmenopausal women according to tumor characteristics. J Natl Cancer Inst. 2011;103(15):1179-1189
2 Bertrand KA, Tamimi RM, Scott CG, et al. Mammographic density and risk of breast cancer by age and tumor characteristics. Breast Cancer Res. 2013;15(6):R104.
3 Friedewald SM, Rafferty EA, Rose SL, et al. Breast cancer screening using tomosynthesis in combination with digital mammography. JAMA. 2014;311(24):2499-2507.

To view the original version on PR Newswire, visit:http://www.prnewswire.com/news-releases/study-results-published-in-jama-conclude-that-3d-mammography-exams-outperform-conventional-mammography-for-women-with-both-dense-and-nondense-breasts-300257824.html

SOURCE Hologic, Inc.

Related Links

http://www.hologic.com

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Rating

2 Star

Categories

Breast cancer, industry/commercial news releases, Screening tests

Tags

3D mammography, digital mammography, Hologic, overdiagnosis

Study Results Published in JAMA Conclude that 3D MAMMOGRAPHY™ Exams Outperform Conventional Mammography for Women with Both Dense and Nondense Breasts

Our Review Summary

Digital mammographyThis news release describes the results of a large population-based study comparing several screening outcomes (including recall rates and  cancer detection rates) between digital mammography and digital mammography plus tomosynthesis (i.e., Hologic Genius 3D mammography). Although the published study did find a significant difference between the two screening modalities by breast density tissue, the rates were not significant in women with extremely dense breasts. A point the news release failed to mention.

Another caveat is that the original research did not look at healthcare savings or any clinical outcomes. But the manufacturers of the 3D mammography tout the the potential savings and improved outcomes in the news release, suggesting to readers that these outcomes are to be expected when their technology is used.

 

Why This Matters

Better detection of breast cancer through newer technology is not the same as improving clinical outcomes. Failing to mention that women with extremely dense breasts did not benefit from the newer technology can lead to more confusion for women who may falsely assume the new technology will help them.

This release also catches a coat-ride on new legislation adopted by about half of U.S. states that require that women receive notifications of their breast density (BRN) along with their screening mammogram results. These mandated notifications on breast density are not well-regarded by a number of experts since their value to patients is questionable. What are women to do with this information?

Criteria

Does the news release adequately discuss the costs of the intervention?

Not Satisfactory

No discussion of costs or whether the addition of the 3D mammography is covered by insurance policies. This is a huge oversight considering the release touts the potential for significant cost savings. For example, the release states:

“This has the potential to provide health systems and insurance companies with significant cost savings, reduce patient stress and expenses, and alleviate challenges for referring physicians who are tasked with relaying mammography results to their patients.”

A quick online scan of the cost for this newer technology finds that although the 3D test is FDA-approved, it still isn’t covered by most insurance plans.  At least one large clinic using the 3D technology asks patients for an an out-of-pocket payment of $60 and then the 2D portion of the imaging test is billed to insurance. The patient is liable for any outstanding balance after insurance has paid.

Does the news release adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

The news release mentions a 50% increase in invasive cancer detection which on the surface sounds impressive, but they don’t provide enough detail to understand what the 50% increase really means. According to the original study, the digital mammography plus tomosynthesis increased detection of invasive cancers from 3 per 1000 screens to 4.5 per 1000 screens and this high percentage increase was seen in only one of the four groups of breast tissue density. The other two groups had lower increases. (“Mammograms are categorized into four density groups: almost entirely fat, scattered fibroglandular densities, heterogeneously dense, and extremely dense,” according to the release.)

The news release failed to mention that in women with extremely dense breasts, the 3D mammography was not significantly better at detecting invasive cancer than digital mammography alone. The published study called for caution “in drawing conclusions regarding the performance of tomosynthesis [3D mammography] for the small proportion of women with extremely dense breasts.”

We also question the release’s portrayal of 3D mammography providing a “high percentage increase” in detection over conventional mammography. Our calculations show a 0.15% increase in detection rates (0.3% detection rate for conventional vs. 0.45% for 3D).

Finally, we need to address outcomes. There is no evidence from the study that finding these additional cancers leads to better outcomes. Finding more cancers with a more sensitive test could be leading to over-diagnosis. Furthermore, the value of finding these cancers earlier is of uncertain value in the absence of outcomes data–which ideally should come from a randomized trial to avoid bias in lead-time.

The many broad claims in the release are not fully supported by the evidence.

Does the news release adequately explain/quantify the harms of the intervention?

Not Satisfactory

There were no explanations of potential harms of integrating 3D mammography into current breast cancer detection or that this technology does not appear to benefit women with extremely dense breasts. It is unclear if this technology could result in false positives (over-diagnosis) or what the negative predictive value of the test is (the probability that subjects with a negative screening test don’t actually have the disease).

If these tests lead to over-diagnosis then women face the harms (and costs) of unnecessary treatment.

Does the news release seem to grasp the quality of the evidence?

Not Satisfactory

Although the research letter in JAMA noted that adding tomosynthesis did not produce a significant result in detecting breast cancer for women with extremely dense breasts (one of the four categories of breast density), the news release does not mention this limitation to the study. The news release also takes the evidence from the study and extrapolates to health care savings costs and increased quality of care for women, neither of which were examined in the study. In fact, the original study did not look at clinical outcomes and noted this as a limitation, but the news release does not discuss this caveat.

Furthermore, we do not know whether the apparent benefits — in terms of increased cancer detection and decrease in recalls — would be mirrored in routine practice. The results were based on mammograms being performed by high volume sites in a clinical trial. The published research also noted that the study included “insufficient follow-up to determine if increased invasive cancer detection improved clinical outcomes.”

Does the news release commit disease-mongering?

Satisfactory

The report did not appear to engage in disease mongering.

Does the news release identify funding sources & disclose conflicts of interest?

Not Satisfactory

The news release is distributed by the company that makes the 3D mammography so we can assume it played a role in funding the study. What’s troubling is that the release gives no mention of potential conflicts of interest — or the absence of conflict — among the many investigators involved with the study. The published research notes that none of the researchers reported a potential conflict but that five of the researchers received research grant funding from Hologic. Also concerning is a note included with the disclosure section of the study: “The study contracts and data sharing agreements specified that Hologic had the right to review all publications prior to submission, but could not mandate any revision of the manuscript or prevent submission for publication.”

At bare minimum the release should have noted that at least some of the researchers received grant funding from the manufacturer.

Does the news release compare the new approach with existing alternatives?

Satisfactory

The purpose of study compared digital mammography alone with digital mammography with the addition of 3D mammography.

Does the news release establish the availability of the treatment/test/product/procedure?

Satisfactory

The news release does mention that 3D mammography has been available since 2011 and includes a link to a website where people can enter their zip code to find locations that offer the additional screening test.

Does the news release establish the true novelty of the approach?

Not Satisfactory

The claim to novelty is found in this statement in the release:

“This new analysis confirms that Genius™ 3D MAMMOGRAPHY™ exams reduce unnecessary follow-up exams in dense-breasted women. This has the potential to provide health systems and insurance companies with significant cost savings, reduce patient stress and expenses, and alleviate challenges for referring physicians who are tasked with relaying mammography results to their patients.”

For the reasons stated above, we think the release makes questionable claims and therefore fails the novelty test so we’re rating this not satisfactory. In addition, the 3D screening technology has been available since 2011.

Does the news release include unjustifiable, sensational language, including in the quotes of researchers?

Not Satisfactory

While the release generally uses appropriate language, we’re flagging it for the claim that “an estimated 10 million women in the U.S. benefited from a Genius exam.” Even if 10 million women received exams, not all of them benefited. We think the release should have included some backup for a claim this bold.

Total Score: 3 of 10 Satisfactory

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