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New 3-D mammogram option the next step in diagnosis, treatment

Chief Hospital Corpsman Naomi Perez, a certified mammogram technician (left), conducts a mammogram for a patient at Naval Hospital Pensacola. A mammogram is a low-dose X-ray procedure used to detect the early stages of breast cancer. A policy change effective Jan. 1, 2020, will allow digital breast tomosynthesis, or 3-D mammography, to be used to screen for breast cancer. The procedure – known technically as Digital Breast Tomosynthesis (DBT) – will be offered primarily to women age 40 and older, and women age 30 and older who are considered high-risk for breast cancer.  The procedure’s 3-D images provide a more thorough means of detecting the disease. (U.S. Navy Photo by Mass Communication Specialist 1st Class Brannon Deugan) Chief Hospital Corpsman Naomi Perez, a certified mammogram technician (left), conducts a mammogram for a patient at Naval Hospital Pensacola. A mammogram is a low-dose X-ray procedure used to detect the early stages of breast cancer. A policy change effective Jan. 1, 2020, will allow digital breast tomosynthesis, or 3-D mammography, to be used to screen for breast cancer. The procedure – known technically as Digital Breast Tomosynthesis (DBT) – will be offered primarily to women age 40 and older, and women age 30 and older who are considered high-risk for breast cancer. The procedure’s 3-D images provide a more thorough means of detecting the disease. (U.S. Navy Photo by Mass Communication Specialist 1st Class Brannon Deugan)

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After nearly a year’s effort, a policy change effective Jan. 1, 2020, will allow digital breast tomosynthesis, or 3-D mammography, to be used to screen for breast cancer. While the procedure may not be offered at all military treatment facilities, the expanded benefit will be available as a screening and diagnostic tool for beneficiaries with TRICARE coverage.

The procedure – known technically as digital breast tomosynthesis or DBT – will be offered to primarily women age 40 and older, and women age 30 and older who are considered high-risk for breast cancer. Practitioners can offer DBT to other patients should a diagnosis determine the presence of a risk factor

The procedure’s three-dimensional images provide a more thorough means of detecting the disease – particularly in patients with dense breast tissue. The digital breast tomosynthesis technique is similar to that of a CT (computed tomography) scan. The source of the CT X-ray repeatedly sweeps over the breast at spaced intervals. The final imagery offers a cross section of “slices,” or adjacent segments, of tissue.

"Mammography is the gold standard in detecting breast cancer, and the DHA is pleased to bring this advanced form of imaging to our patients," said Dr. Paul Cordts, chief medical officer for the Defense Health Agency. "We know how important it is to our patients to have access to the latest technology to improve their health outcomes. Digital breast tomosynthesis allows for earlier detection and diagnosis of smaller cancers and, if discovered early, it opens up more options to treat it quickly while in a nascent stage, with improved outcomes and potentially less side effects."

According to Amber Butterfield of TRICARE’s Medical Benefits Reimbursement office in Aurora, Colorado, the expanded benefit for breast cancer screenings is allowed through provisional coverage authorized by Assistant Secretary of Defense for Health Affairs Thomas McCaffrey. Provisional coverage is a special authority that allows extension of coverage for items that are undergoing evaluation or have beneficial effects not yet proven.

Between 2016 and 2018, roughly 80,000 TRICARE beneficiaries were diagnosed with either malignant abnormal growths of the breast, called carcinomas, or pre-cancerous cells, called neoplasms. To address this, leaders at the DHA were determined to find a way to expand breast cancer screenings using the DBT technology, while adhering to congressional requirements as they pertain to provisional authority.

“By regulation, TRICARE follows guidelines from the U.S. Department of Health and Human Services for preventive services,” Dr. James Black, medical director of the Clinical Support Division at DHA, said. “This includes the U.S. Preventive Services Task Force, which gives recommendations on provisional preventive services.”

Although the task force has yet to recommend DBT for cancer screening, the decision by DHA leadership to expand DBT to annual cancer screenings was made a year ago. Since the USPSTF does not currently recommend DBT as a more effective screening tool than 2-D mammography, the DHA had to find a way to offer coverage under current statutes that govern what health services TRICARE can provide beneficiaries.

Black cited the efforts of retired Navy Vice Adm. Raquel C. Bono, the former DHA director, along with subject-matter experts from the services, who provided guidance that led to the provisional adaptation of DBT coverage.

Their focus included which commercial insurance carriers cover DBT and other coverage criteria. From there, DHA’s medical benefits and reimbursement section put together a provisional coverage determination and submitted it to the office of the Assistant Secretary of Defense for Health Affairs – who, by law, is the approval authority for any such changes. The coverage determination was approved in September and coverage will begin Jan. 1, 2020.

Although the task force has yet to recommend 3-D breast DBT for cancer screening, DHA leadership is confident that within the five years DBT has been approved on provisional authority, the USPTF will obtain enough research to reach a firm recommendation.

Beneficiaries who have questions about DBT services offered in locations convenient to them should contact their TRICARE provider or regional customer service call center.

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