San Francisco, Cali., November 22, 2013 — The California Technology Assessment Forum (CTAF), a flagship initiative of the Institute for Clinical and Economic Review (ICER), has produced a new Technology Assessment Report and Action Guide on supplemental cancer screening for women with dense breasts. The Report and Action Guide are based on a recent public meeting of CTAF where the evidence on different screening options was reviewed and recommendations made to guide practice and policy.
Following laws enacted in several other states, on April 1, 2013 a new law went into effect in California requiring mammography facilities to inform women with dense breasts about the potential for dense breast tissue to obscure small cancers and make them invisible on mammography. While several options exist to supplement mammography with additional screening tests, no independent body had reviewed the comparative evidence to evaluate the potential risks and benefits of additional screening for women with different overall risks of breast cancer.
“Providing an objective review of evidence to support actionable information for patients, providers, and payers is the primary goal of CTAF,” stated Steven D. Pearson, MD, MSc, President of the Institute for Clinical and Economic Review. “The Report and Action Guide tackle a complex clinical area involving multiple treatment options about which there are important concerns regarding comparative effectiveness and value. We will work with patient groups and other decision makers to help them apply the Report and Action Guide in their efforts to improve care for these women.”
The Technology Assessment Report titled, “The Comparative Clinical Effectiveness and Value of Supplemental Screening Tests Following Negative Mammography in Women with Dense Breast Tissue,” discusses the relative importance of dense breasts as a risk factor for breast cancer, compares the clinical effectiveness and value of four technologies – Magnetic Resonance Imaging (MRI), Digital Breast Tomosynthesis (DBT), Hand Held Ultrasound (HHUS), and Automated Breast Ultrasound (ABU) – used to enhance screening in women with dense breasts, and considers the relative risks and benefits of supplemental screening for women with different overall breast cancer risk. The CTAF Panel voted that the evidence supports supplemental screening of women at high risk for breast cancer, and that screening with MRI, among commonly used screening technologies, had the strongest evidence for use in these high-risk patients. In addition, when asked to judge the value of performing supplemental screening in women with dense breast tissue using each test (MRI, ABUS, and DBT) compared to HHUS, a majority of CTAF voted that MRI and ABUS represented high or reasonable value. Further, a majority of CTAF voted that DBT represented low value compared to HHUS.
Researchers from the University of California San Francisco, the University of Washington, and the Institute for Clinical and Economic Review all contributed to the report, which is available at www.ctaf.org/assessments.
The Action Guide, a companion policy guide to the full report, provides a practical list of evidence-based action steps and resources tailored to help different stakeholders interpret and apply the evidence to policy and practice. Three sections, targeting patients, clinicians, and health insurers, provide information for individuals or organizations looking to apply the best available evidence and expert opinion regarding supplemental cancer screening for women with dense breasts. In addition, a stand-alone patient information sheet is also available for use by patients and physician practices. The patient information sheet is available in both Spanish and English. To view the Action Guide, go to www.ctaf.org/assessments.
The California Technology Assessment Forum (CTAF), a flagship initiative of the Institute for Clinical and Economic Review, is dedicated to providing credible, evidence-based information about new and emerging medical technologies and delivery system interventions. Lead funding is provided by the Blue Shield of California Foundation. For more information about CTAF, please visit www.ctaf.org.
The Institute for Clinical and Economic Review (ICER) is an independent non-profit healthcare research organization dedicated to improving the interpretation and application of evidence in the healthcare system.