Texas nears decision on mandated DBT screening

Texas may become the seventh state to mandate coverage of digital breast tomosynthesis (DBT) under private insurance plans, as long as Governor Gregg Abbott signs the bill that’s been on his desk since May 30. If Abbot does nothing for 21 days, the bill will become law without his signature, a legislative tactic allowing a bill to pass without signing it.

Texas could join the ranks of Arkansas and Maryland, who both mandated DBT coverage this year. Other states with previously passed legislation include Connecticut, Illinois, New Jersey and Pennsylvania.

DBT is rapidly becoming the standard for screening mammography, thanks to its semi-3D image construction which can minimize the obfuscating effect of dense breast tissue. While DBT image file sizes are 10 to 20 times larger than their traditional 2D counterparts, the costs of data storage have been dropping precipitously and are expected to keep falling, according to Data Center Journal.

Large screening trials have shown greatly improved accuracy, with a recall rate reduction of around 15 percent. It’s also reduced false positive rates, regardless of a women’s age or breast density, according to a study published in the American Journal of Roentgenology (AJR).

Improved specificity and sensitivity could spike diagnosis for low-grade cancers, but most studies show that recall rates remained low—including a University of Pennsylvania study that reported lowered recall rates for three years after the implementation of DBT.

Other studies have shown high consensus on radiologists using DBT to classify breast density, providing another avenue for DBT to add value to an imaging practice.

“Tomosynthesis first entered the breast imaging clinical arena in 2011 and has quickly emerged as a practice-changing standard,” wrote the authors of the AJR study. “The improved accuracy and overall efficiency that DBT can provide will enhance radiologists’ performance and improve the patient experience.”

DBT coverage legislation is also moving through the legislative process in Massachusetts, New Hampshire, New York and Ohio.