The local hospital facility is adding a new piece of equipment designed to provide women with a more accurate breast cancer detection screening modality.
Northern Inyo Hospital’s Board of Directors recently said yes to Radiologist Dr. Stuart Souders’ request to add a state-of-the-art somo•V Platinum Automated Breast Ultrasound System to NIH’s breast cancer prevention arsenal.
Souders’ pitch hinged on the fact that the ABUS would substantially decrease the number of cancers missed by using mammograms alone. The ABUS is 60 percent more effective than the current standard mammography imaging equipment, said Souders. Currently, “four of 10 cases are going undiagnosed, almost always in dense-breasted women.”
In the mammography of fatty breasts, explained Souders, the X-ray screens through the tissue easily and detects up to 99 percent of cancers. Not so with dense-breasts. According to NIH Radiology Director Patty Dixon, the approximately 2,000 annual mammograms done at NIH reveal that “40 percent of our patients are dense-breasted.” Souders added that “we were missing 30-50 percent of cancers in dense breasted women using mammography alone.”
Dense breasts are caused by varying amounts of glandular or fibrous tissue which hide the cancers from x-rays taken by standard full-field digital mammography units, Souders explained. Trying to discern a potentially malignant mass from normal tissue, especially in this population of women, is “like looking for a snowball in a snow storm.”
Since the early ’90s when ultrasound became a regularly-used modality, it was only used when an abnormality was detected by mammogram or by self-examination, explained Souders. “The handheld ultrasound devise took 45 minutes, was operator-dependent and had to be used by experts. However, screening should be quick, easy and reproducible.”
This is where ABUS comes to the rescue. “It screens every millimeter of the breast,” said Souders. The cancer detectability rate goes up to 90 or 98 percent for dense-breasted women, by adding ultrasound exams to mammographic exams, said Souders and ABUS decreases the number of false negative exam results. ABUS compliments mammograms in dense-breasted women” – they should have both procedures done.
It only takes three minutes per breast to do an exam using ABUS, said the radiologist, a perk not only for the patient but also for the hospital. “The medical insurance reimbursement is the same for a three-minute exam done by a radiology technologist as it is for a 45-minute exam done by a doctor,” said Souders. Furthermore, he explained, with the ABUS, NIH “would be the first and only system in the Eastern Sierra” – and probably from Reno to Ventura.
The Food and Drug Administration approved ABUS “in September 2012 and in within two months, G.E. bought (its manufacturer, U-Systems, Inc.). They know what it’s worth.” Souders was part of the 17-member team of mammography experts selected to conduct the final FDA-required evaluation, which involved 200 mammograms cases.
According to NIH Director of Community Development, Marketing and Grant Writing Angie Aukee, the hospital has submitted a $195,000 purchase proposal. “We are waiting for G.E. to come back to us with a new purchase price or a lease,” said Aukee.
“Worst case scenario,” said John Halfen, NIH’s chief financial officer as well as its chief executive officer, “we’ll have to lease from G.E. on the shortest possible term” until the equipment can be purchased outright. The NIH Board of Directors has granted Halfen up to $200,000 with which to negotiate the deal. Aukee added that NIH is also “trying to solicit funds from local agencies and service organizations to help offset some of that cost.” She said that she is optimistic about hearing back from those entities by March at the very latest. Halfen said he anticipates that ABUS will be operating at NIH radiology department by next month.
According to California 11th District Senator Joe Simitian’s website, www.senatorsimitian.com , his bill, the SB 1538 Comprehensive Breast Tissue Screening mandates that, effective April 2013, “under federal law,” a radiologist’s report to the referring physician must include the patient’s breast density information. It must also be sent to the patient informing her that other screening modalities are available, added Souders.
Aukee explained how ABUS works to detect potential cancers, quoting information gleaned from both Souders and U-Systems documentation. “The system utilizes convergent scan line geometry which allows sound waves to penetrate the skin perpendicularly which minimizes beam refraction, improves penetration and sharpens focus. It also allows us to generate a 3D image at the reading station.” In short, ABUS’ scanner matches women’s anatomy and is “designed to deliver superior imaging performance and patient comfort.”
It reveals a display of the internal breast anatomy, from skin to the chest wall in two millimeter sections, documenting the location of all findings and allowing the images to be viewed in three dimensions: distance from the nipple; distance from the skin and clock position – with the nipple as the center of the clock, masses can be pinpointed at two o’clock, for example, if it appears in that part of the upper right quadrant.
Souders said that he expects a law will soon be passed, mandating insurance companies to pay for ABUS screenings. And the We Care: Early Breast Cancer Detection Program, which covers standard mammograms for a $10 co-pay for eligible women, may also cover ABUS exams in the future but that has yet to be determined, said Aukee.
For more information about mammograms, call the radiology departments at NIH, (760) 873-2155, and at Mammoth Hospital, (760) 934-3311.