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The
Value of Mammography Recall — Study Finds Surprisingly Low Cost
Diligent mammography recall procedures can save lives. Yet the important clerical task is too often considered a costly, time-consuming nuisance. Researchers at the University of Michigan Health System studied their recall procedures and found it surprisingly inexpensive—16 cents per screening patient—to achieve a 99.5% recall compliance rate. “Departments are continually trying to trim waste and eliminate overhead costs in this era of spiraling health costs,” said Caroline Blane, MD, lead researcher of the study and radiology department associate chair for clinical services. “We use clerical time to track down noncompliant patients to schedule them and the question arose as to how high was the cost of this clerical time and how much benefit was derived.” Blane presented the study results at the 2006 annual meeting of the American Roentgen Ray Society (ARRS) in Vancouver in April. Between 2002 and 2004, 4,025 patients of 30,286 who received screening mammograms at the health system were recalled for another mammogram. The researchers performed a cost analysis on those cases, calculating the clerical time to make the calls—using a $17-per-hour (including salary and benefits) rate for the time used. Of those 4,025 patients, 3,977 (98.8%) returned for a diagnostic study after an average of two phone calls, which averaged 3.65 minutes of total clerical time and cost $1.03 per case. Forty-eight of 4,025 (1.2%) initially noncompliant patients received an average of six phone calls (totaling 4.7 minutes), plus clerical costs for this group of $2.27 with the additional cost of $7.50 for a registered letter, totaling $9.77 per case. Twenty-eight of this group returned for additional screening and the study discovered one of these initially noncompliant patients went on to biopsy revealing breast cancer. The total cost for the program was $4,581.84 or 16 cents per screening patient. “The surprising part was how little it added to the cost of each screening study, 16 cents, to achieve this compliance,” Blane said. “As noted in the study, one of the initially noncompliant patients did have an early curable breast cancer which was appropriately treated because we have this safety net and spent the time and so little money getting her to return for a diagnostic mammogram. If for every 30,000 screening mammograms we pick up one early breast cancer, I believe a delay in diagnosis of this one breast cancer would have cost considerably more in the long run than the 16 cents per screening mammogram. Not only are we providing a patient service with improved patient outcome but we are probably also saving healthcare dollars.” Mammography Expectations “Women have high expectations of mammography because patients in general—not specifically women—tend to have a view of all medical tests being yes or no, ‘positive’ or ‘negative,’” said the University of Michigan Health System’s Marilyn Roubidoux, MD, a coinvestigator of the study. “The general public as well as some healthcare professionals do not completely understand concepts of accuracy, sensitivity, specificity, false negatives, and false positives. People assume that if a mammogram can detect cancer the size of a pin, then it can detect all cancers bigger than a pin. The reality is much more complicated than that.” Roubidoux and her colleagues certainly were not surprised by such high expectations and part of the point of the patient survey was to measure the impression. They found that a substantial proportion of women have beliefs about their personal risk of breast cancer, and expectations about the performance of mammography that are abnormally high or unrealistic. A survey was administered to women who came to an outpatient clinic for screening mammography. The participants were 397 women ranging from 40 to 83 years old. The responses to the survey questions showed that 16% thought their personal risk of breast cancer was 50% or higher—much higher than the American Cancer Society numbers indicating that the chance of a woman having invasive breast cancer some time during her life is roughly one in eight. Approximately one fifth of the women surveyed (20.6%) agreed with the statement “mammograms detect all breast cancers” and 11.4% were neutral about the statement. “The results in the survey were expected,” Roubidoux said. “After working with patients for many years and doing their biopsies, their beliefs about mammography are revealed in conversations and these now are shown in a more objective way in the survey.” The study’s primary objective was to identify factors that may predict what factors drive to have repeat mammograms. By identifying those factors, they hope to develop ways to improve mammogram compliance. Behavior Predictors “As stated, women in this study were highly educated and likely well-informed about procedures such as mammograms. With more information, expectations are more accurate, thereby minimizing the negative physical and emotional aspects associated with this type of procedure,” said Tang. While unrealistic expectations may complicate matters, the facts show that screening mammography works and increasing compliance will decrease the number of lives lost to breast cancer. — A Radiology Today staff report Image-Guided Biopsy
Aids Kidney Tumor Planning “When a patient has a kidney mass, it isn’t always clear what the treatment should be until we know the tissue type. Sometimes getting a small sample of tissue can make the difference between major surgery [partial or complete removal of the kidney] or a simple follow-up CT scan. If a mass is benign, a patient has been spared the loss of a kidney and may actually need no treatment at all. If a mass is malignant but something other than a cancer of kidney origin, the treatment may involve chemotherapy, radiation, or another type of surgery entirely,” said Katherine Maturen, MD. Researchers reviewed 153 kidney biopsies in 126 patients and found that more than 60% of patients had a change in their treatment—whether surgery, tumor ablation, chemotherapy, or radiation—due to biopsy results, and that as many as 75 unnecessary kidney removals were potentially avoided. These biopsies are performed under conscious sedation with local anesthesia to numb the skin where the needle will enter. The procedure takes approximately 30 minutes and the patient usually returns home after a four-hour observation period. “When a patient has a kidney mass, options include an open surgical procedure or an image-guided percutaneous biopsy,” Maturen said. “…Imaging guidance [either ultrasound or CT] allows us to watch our needle as it enters the mass, decreasing the risk of damage to adjacent structures and ensuring that we are sampling the correct tissue.” According to the researchers, although the acceptance of percutaneous image-guided biopsy has increased among physicians in recent years, many continue to avoid the biopsies because of concerns about poor sensitivity and a high rate of nondiagnostic biopsy, all based on data from old techniques including fine needle aspiration. “We felt it was important to demonstrate that newer core biopsy techniques have a much greater success rate, and to quantify the extent to which these biopsies altered patient management,” Maturen said. — Source: American Roentgen Ray Society
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June
5, 2006
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