– New Report from the New England Comparative Effectiveness Public Advisory Council (CEPAC) Emphasizes that Supplemental Screening Tests All Have Potential Risks and Benefits–
Boston, Mass., March 5, 2014 – The New England Comparative Effectiveness Public Advisory Council (CEPAC), a flagship initiative of the Institute for Clinical and Economic Review (ICER), has produced a new Evidence 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 CEPAC where the evidence on different screening options was reviewed and recommendations made to guide practice and policy.
Laws have been enacted in over a dozen states requiring mammography facilities to inform women when their mammogram results reveal they have dense breast tissue, which may mask abnormalities in some circumstances, and to notify them of options for supplemental screening such as ultrasound and MRI. Connecticut was the first U.S. state to enact breast density notification legislation, and other states in New England are considering similar policies. The issue has also caught the attention of Congress, where breast density notification legislation has been introduced. There is uncertainty regarding the effectiveness of supplemental screening in women at different levels of overall breast cancer risk, however, and concerns about the potential for these tests to produce false-positive results that might lead to unnecessary testing and treatment.
“As breast density notification legislation becomes more widespread, an objective review of the evidence to support patient, provider, and payer decision-making is critical,” 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 screening options about which important concerns regarding comparative effectiveness and value exist. Our goal with these materials is to make the evidence more accessible and understandable for decision-makers across the health care spectrum.”
The evidence review 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, considers the relative risks and benefits of supplemental screening for women with different overall breast cancer risk , and compares the clinical effectiveness and value of four technologies used to enhance screening in women with dense breasts: magnetic resonance imaging (MRI), digital breast tomosynthesis (DBT), hand held ultrasound (HHUS), and automated breast ultrasound (ABUS). This review builds on a recent effort undertaken by ICER’s other flagship initiative, the California Technology Assessment Forum (CTAF), that considered this topic as it relates to the California population. The CEPAC report includes an evidence review as well as supplemental information for New England, including regional and national payer coverage policies, region-specific utilization patterns, new evidence, and a budget impact model for New England.
CEPAC voted that the strongest 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, a majority of CEPAC judged MRI to have high or reasonable value compared to HHUS, the lowest cost supplemental screening test, for women with dense breast tissue and high risk of breast cancer.
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. Both the Action Guide and patient aid are available for download on the CEPAC Website.
CEPAC, an independent, regional body of practicing physicians, methodological experts, as well as patient/public members, provides objective, independent guidance on the application of medical evidence to clinical practice and payer policy decisions across New England. Led by the Institute for Clinical and Economic Review, CEPAC was originally funded by a federal grant from the Agency for Healthcare Research and Quality (AHRQ), but is now supported by a broad coalition of state Medicaid leaders, integrated provider groups, public and private payers and patient representatives. For more information on CEPAC, please visit cepac.icer-review.org.
The Institute for Clinical and Economic Review (ICER) is an independent non-profit health care research organization dedicated to improving the interpretation and application of evidence in the health care system. For more information about ICER, please visit ICER’s newly redesigned website: www.icer-review.org.