November 24, 2014

ACR Statement on Breast Tomosynthesis

The American College of Radiology (ACR) is committed to ensuring that women have ready access to breast cancer screening. Ample data shows that regular mammography screening significantly reduces breast cancer deaths. Currently, more than 95 percent of mammography units in the United States are full-field digital. A large body of literature validated its clinical benefits over film screen mammography. Digital mammography offers many other advantages, including rapid and reliable electronic storage and retrieval of images, easy image transfer to other facilities, and simplification of quality control.

A new digital technology, breast tomosynthesis has shown to be an advance over digital mammography, with higher cancer detection rates and fewer patient recalls for additional testing. This is extremely important. The medical community has long sought ways to improve breast cancer screening accuracy. Better sensitivity will likely translate into more lives saved. Lower recall rates result in fewer patients who may experience short-term anxiety awaiting test results. This is important evidence that tomosynthesis will have a positive impact on patient care. ACR presented this evidence during the evaluation process for the new Current Procedural Terminology (CPT) codes 77061, 77062 and 77063 which were developed for CPT 2015.

As this technology is used in clinical practice, we anticipate that further studies will clarify its impact on long-term clinical outcomes, including reduced mortality. It will also be important to further elucidate which subgroups of women might benefit most from these exams (by age, breast density, frequency of examination, etc.).

To facilitate such large scale outcome data collection, the technology must be widely available. Availability is greatly impacted by reimbursement for the service provided. The College applauds the decision by the Centers for Medicare and Medicaid Services (CMS) to facilitate access to these exams by covering beneficiaries for tomosynthesis and urges private payers to do the same.

To be clear: tomosynthesis is no longer investigational. Tomosynthesis has been shown to improve key screening parameters compared to digital mammography.

While the College encourages more studies to clarify the clinical role(s) of tomosynthesis and its long-term outcomes, it is clear that tomosynthesis represents an advance in breast imaging. The ACR will continue to update members and external stakeholders on this important matter.