The Mercury Bay Medical Equipment Trust (MBMET) has submitted a proposal for Breast-screening of the Eastern Coromandel women to BreastScreen Aotearoa (BSA) and BreastScreen Midland (BSM) which will deliver better patient outcomes and save money in the health budget.
It does this by:
- Transitioning breast screening to the more accurate 3D mammography from the current 2D technology which results in savings by finding breast cancers earlier.
- Moving to a more cost-effective, more accessible fixed mammography site in Whitianga rather than running a mobile unit.
- Giving access to women of all ages on the Coromandel Peninsula to have a screening mammogram through a public-private partnership.
The case for the transition to 3D tomosynthesis Breast screening for women on the Coromandel Peninsula
3D mammography is 40% more accurate than 2D mammography. It reduces the number of false positives compared to 2D Digital mammography used for screening mammograms in the public system. Still, the increased accuracy comes at an additional cost, as each 3D mammogram takes up more storage space in the medical imaging PACS system.
In our discussions with BreastScreen Aotearoa (BSA) they cite this cost as the reason for not transitioning to the newer, more accurate 3D technology.
Using the results of two published international research studies below and applying this to the “all of patient costs” of breast cancer, not just the screening costs, we can show that the savings outweigh the additional costs of storage and improve patient outcomes.
◾️The websites for these studies and BSA’s article can be found in the footnotes at the end of this article
Research Study 1
Ten-year study shows that tomosynthesis improves breast cancer detection.
This research study is the first to compare 10 years of data on breast cancers detected by 3D mammography in comparison to 2D mammography detected cancers
The key findings of this study are:
- 2D mammography, in which a low-dose X-ray system produces pictures of the inside of the breast from 2 angles, fails to detect 20% of breast cancers.
- Screening for breast cancer with 3D mammography increases cancer detection rates and significantly reduces the rate of advanced cancers compared to conventional 2D digital mammography.
- 3D found more aggressive cancers at an earlier stage compared to 2D mammography.
- Cancer detection was improved when women had repeat 3D mammograms.
- Most true-positive cancer cases detected by 3D presented as masses, while fewer presented as calcifications and asymmetries(false positives).
- The recall rate for 3D was significantly lower than for 2D mammography.
- “3D’s lower recall rate, higher cancer detection rate and lower rate of advanced cancers is a win, win, win,” Dr Philpotts, one of the co Authors said.
Research Study 2
‘3D mammography’ almost halves the incidence of breast cancer between the two screening tests.
The Key findings in this research are as follows.
- Almost 24,000 women were examined only with 2D mammograms, while another group of 16,000 was evaluated with both 2D mammograms and 3D mammography.
- According to the results, the interval cancer rate was 1.8 per thousand people in the first group, and 0.93 in the second.
- In other words, the likelihood of being diagnosed with an interval cancer was 49% lower in women who were also screened with the 3D mammogram.
A WIN/WIN/WIN
1. Patient Benefits
- 3D screening mammograms achieve higher accuracy, detect cancers earlier, reduce false positives, and lower rates of interval cancers, resulting in better patient outcomes.
- Fewer trips to Hamilton and less anxiety for the patient due to false positives.
- Fewer deaths due to the late diagnosis of breast cancer.
2. Savings for BSA, BSM and Health NZ budget.
- Fewer diagnostic workups at Waikato Hospital due to fewer false positives
Having more tests after a mammogram – English – HE10118
This is a document from BSA ‘s website and states:
When 100 women have a mammogram through Breast Screen Aotearoa, about 5 are asked back for further tests because something looks unusual. Four out of these five women will not have breast cancer, and one woman will be diagnosed with breast cancer. So this means 4 false positives per 100 patients
- Study No 1 shows that false positives are reduced using 3D screening, so if only two of the four false positives of the 100 women above did not have to travel to Waikato hospital for a minimum 2-hour diagnostic workup, the savings to Health NZ Te Whatu Ora would be at least $700 per patient or $1,400 per 100 women screened.
- Study No 2 shows the increased accuracy of 3D mammography means patients are significantly less likely to be diagnosed with Interval cancers.
Both research studies conclude 3D breast-screening finds breast cancers earlier meaning the downstream cost of treating these cancers is significantly lower for Health NZ Te Whatu Ora due to
- Reduced treatment times.
- Less invasive surgeries and fewer hospital bed days.
- Shorter outpatient times.
We contend that the above savings alone will more than pay for the additional storage costs of 3D screening mammograms.
3. Fixed site versus mobile unit for screening mammograms on the Eastern Coromandel.
A fixed site unit provides weekly access for all women on the Coromandel Peninsula who wish to have breast screening, either through the public or private systems, compared to the existing mobile system, which provides access at set times to women between 45 and ultimately 74 during the year when women must be available to attend.
Our fixed unit will provide easy access to those with a disability by having covered in accessible parking, no stairs to navigate, wheelchair access through 2-metre-wide corridors to a waiting room, wheelchair friendly changing rooms and accessible toilets. These features are not available in a mobile unit.
Recent correspondence from BSM via the Minister of Health appears to offer 4 visits to Whitianga annually by the mobile unit to improve accessibility, which would substantially increase the cost of providing the existing service.
Our proposal outlines the benefits and cost savings to BSM of the fixed site as follows.
Mobile units are far more costly to run than fixed units.
In our offer to BSA, we clearly stated that the 400 private mammograms they took could be paid for at $100 per mammogram, totalling $40,000.
The lease cost of the fixed unit, including fitout and shared spaces and carparking for patients and staff at our brand-new site in 27 Campbell Street, would be approximately $20,000 per annum, so this cost is covered by the revenue from the private mammograms, with a further $20,000 to offset the other operational costs.
In comparison, the additional costs of running the mobile unit would include.
- Repairs and maintenance and running costs of the mobile unit
- COF for the unit.
- Running a separate car for staff travel
- Staff accommodation and meals
- Truck drivers’ salary for the time they move the unit and set it up.
- Annual Capital Provision for replacement of the mobile unit, assuming a 10-year life.
BSM would need to provide their own detailed figures for the above, but we estimate these to be $132,000 for the time it is on the Eastern Coromandel Peninsula
Besides leasing a $350,000 new mammogram machine at a small annual administration cost, our offer also includes a replacement Mammogram machine at the end of 10 years, which saves BSM the need to accrue $40,000 per annum for capital expenditure.
MBMET also recognises the staffing issues in New Zealand, where not enough new mammographers are being trained to replace those who retire each year, and provides a $20,000 grant to recruit a qualified Mammographer from overseas, if necessary, to operate the unit.
We therefore don’t agree with BSM’s claim that they need additional funding to operate a fixed 3D unit in Whitianga.
Rural mammography for women of all ages.
Our Public-Private model ensures that women of any age who wish to have a screening mammogram on the Eastern Peninsula can have one without having to travel 6 hours round-trips to a private clinic.
It makes the best use of an expensive mammogram machine that the community raised money for, and the public-private partnership makes the fixed unit a cost-effective, viable, accessible unit for rural women of all ages and mobility.
Summary
The proposal we have put forward to BSA and BSM requires them to make two changes to the way they operate on the Eastern Coromandel Peninsula:
- To transition to a fixed unit in Whitianga that provides weekly access to breast screening for all women who wish to have a mammogram in our communities
- To embrace the more accurate 3D technology to provide better clinical outcomes for our rural women.
In doing so, HNZ will save operational costs within a health budget under significant strain.
Community Help required
Our community rallied behind this project and raised $350,000 in taxpayer funds for a 3D mammogram machine in a record 2.5 years.
This alone should show that the community’s need is evident. As a trust, we have not received evidence-based reasons from BSA or BSM for why they cannot support our proposal.
We wish to document the community’s support for this cause through a petition. Hence, there is no doubt in the Minister of Health’s mind that our community are serious about wanting this life-saving, more accurate, accessible service for all of our women at a fixed site located in Whitianga.
The petition can be signed at – Tairua, Get It On in the main street; Whitianga, Unichem Stephensons Pharmacy and Mercury Bay Pharmacy. Other sites including Coromandel town to follow shortly.
References:
Research Study 1 ten-year study shows that tomosynthesis improves breast cancer detection.
Research Study 2 ‘3D mammography’ almost halves the incidence of breast cancer between the two screening tests.
BreastScreen Aotearoa’s article
Website: https://healthed.govt.nz/products/having-more-tests-after-a-mammogram-english-version.
