The tides are turning for breast imagers. After several years of declining demand and facility closures, the market is rebounding and more growth is expected.
The tides are turning for breast imagers nationwide. After struggling through several years of declining demand and facility closures, the market is rebounding and more growth is expected.
The number of breast imaging facilities dropped by nearly 7 percent from 2002 to 2011, according to a recent report from global growth consulting company Frost & Sullivan. Roberto Aranibar, a Frost & Sullivan advanced medical technologies industry analyst, said several factors - the rise in breast cancer incidents, an increase in breast cancer surgical procedures, and an uptick in supplemental screening exams - are converging to prompt expansion in this area.
In fact, Aranibar said he anticipates breast imaging market revenues to climb from $1 billion in 2011 to $1.4 billion by 2016, crediting the rise in the number of exams performed. Diagnostic Imaging talked with Aranibar about this report, why the market has changed, and what the industry can expect.
What are the main factors behind the decrease in breast imaging facilities nationwide?
It’s part of a larger trend. There’s consolidation going on among healthcare providers, and individual facilities are reducing their own costs through staff reduction. Using their equipment more efficiently also helps them be more productive. We’re also seeing a lot of mergers between large facilities of chains of facilities. The decrease in the number of these imaging centers is just part of a broader trend.
What caused the drop in facilities to stabilize?
From a broad perspective, there’s a little more certainty in the healthcare industry after the Supreme Court upheld the healthcare reform bill last summer. Some of the major questions and unknowns have been answered. Consequently, it’s helped people better plan their next steps to maintain the stability of their facilities.
What do you expect will happen with breast imaging over the next five years?
There are many different trends going on right now. There’s a lot of controversy around X-ray mammography and its risks and benefits. Based on that, it’s probably the most highly-regulated imaging field. There’s a lot of technological innovation in this area - a lot of new imaging systems with different modalities, including MRI, ultrasound, molecular breast imaging, and tomosynthesis.
I think one of the biggest trends we see is there’s a lot of talk about breast density notification legislation. That’s a major factor when considering what will happen in the market over the next few years. By law, physicians must include in a woman’s mammography results letter if she has been identified as having dense breast tissue, explain the implications, and discuss whether they could benefit from supplemental exams. We saw a major increase in breast ultrasound procedures after the law went into effect in Connecticut. X-ray mammography is a great tool - it’s very efficient, fast, and cost effective, but it’s being questioned more than ever right now for its reliability. That leaves the door open for a lot of supplemental exams to come into the picture, and that’s where more of the growth in this field will be concentrated.
Breast ultrasound is also an area that is expected to grow. In addition, there’s a major study out that could help move tomosynthesis, which is currently really costly and not something that CMS reimburses for, into something that could get the agency’s approval for reimbursement. As soon as something like that happens, and the cost comes down, we’ll start to see it used more. It’s really proven itself to be a reliable and effective tool, and I think you’ll see a lot more of this as facilities try to stay at the forefront of technology. Rather than referring their patients out for supplemental exams, facilities are going to try to keep everything in-house.
Molecular breast imaging is a modality like PET and nuclear medicine. It involves an injection of radioactive tracers, and radiologists look at where those tracers are concentrated. It’s a more tedious process, and there’s as learning curve involved. Facilities must be licensed to handle radioactive material, and the procedure takes longer, is more costly, and it isn’t reimbursable by CMS. There’s work ongoing now to try to prove that molecular breast imaging is more diagnostically reliable in identifying cancers. But there are issues with it currently, such as managing the radiation dose. So, I don’t think it will be affected much as the market starts to grow again.
What impact will the growth in imaging centers have on patient care and radiologist workflow?
Hopefully, for the patients, they’ll have more confidence in their diagnostic results. Whatever their mammography reports say, whether there’s no cancer or more cancer, they can be confident. For the physicians, this is an issue right now with tomosynthesis. It takes longer to interpret exams, so that could disrupt their workflow and have a negative effect on productivity.
But the industry is trying to develop a way to identify which patients do and do not need more comprehensive exams. In doing this, they can ensure they’re only using the extra time on interpreting these images for the patients that really need them. The increase in breast ultrasounds is also having an effect on procedure volumes and calling on facilities to invest more resources to provide these exams in the most cost-efficient manner. Connecticut struggled with this when it first implemented the breast density notification law. Suddenly, they saw a big increase in the demand for supplemental breast ultrasound, and patients had to wait two to six months for an exam. So, as the call for these exams continues to grow, facilities will have to decide how to allocate their resources.
We could also start seeing more automated breast ultrasounds rather than having a technologist sit and hold a probe and manually do the exam. That automatically introduces variability. But if you use the automated way, you can do each exam very quickly with the transducer moving over the breast, and it’s done the exact same way every time.
What is the main message you want this research to impart?
There’s a lot of penetration potential in this market. Breast imaging is an area of interest because there’s so much going on with it. It has one of the most regulated modalities, and there are all these new technologies that have been introduced to provide alternatives or something better to supplement what we already have with X-ray mammography.
And, there are controversies around breast imaging. A few years ago, the U.S. Preventive Services Task Force changed the recommended age for a first mammogram from age 40 for an asymptomatic woman to age 50. There were big outrages from the imaging community, and issues like that have people questioning where the market is going. Will there be demand for it? We found no conclusive evidence that the change in recommendation has affected product volume or the percentage of women being screened. So, there’s definitely penetration potential, especially with alternative modalities.