title: Diffusion of digital breast tomosynthesis among women in primary care: associations with insurance type.
abstract: Digital breast tomosynthesis (DBT) has shown potential to improve breast cancer screening and diagnosis compared to digital mammography (DM). The FDA approved DBT use in conjunction with conventional DM in 2011, but coverage was approved by CMS recently in 2015. Given changes in coverage policies, it is important to monitor diffusion of DBT by insurance type. This study examined DBT trends and estimated associations with insurance type. From June 2011 to September 2014, DBT use in 22 primary care centers in the Dartmouth -Brigham and Women's Hospital Population-based Research Optimizing Screening through Personalized Regimens research center (PROSPR) was examined among women aged 40-89. A longitudinal repeated measures analysis estimated the proportion of DBT performed for screening or diagnostic indications over time and by insurance type. During the study period, 93,182 mammograms were performed on 48,234 women. Of these exams, 16,506 DBT tests were performed for screening (18.1%) and 2537 were performed for diagnosis (15.7%). Between 2011 and 2014, DBT utilization increased in all insurance groups. However, by the latest observed period, screening DBT was used more frequently under private insurance (43.4%) than Medicaid (36.2%), Medicare (37.8%), other (38.6%), or no insurance (32.9%; P < 0.0001). No sustained differences in use of DBT for diagnostic testing were seen by insurance type. DBT is increasingly used for breast cancer screening and diagnosis. Use of screening DBT may be associated with insurance type. Surveillance is required to ensure that disparities in breast cancer screening are minimized as DBT becomes more widely available.
authors.affiliation: Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Cheryl R
authors.identifier: http://orcid.org/0000-0003-3152-4424
authors.initials: CR
authors.lastname: Clark
authors.affiliation: Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.|Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.
authors.forename: Tor D
authors.initials: TD
authors.lastname: Tosteson
authors.affiliation: Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.|The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.
authors.forename: Anna N A
authors.initials: ANA
authors.lastname: Tosteson
authors.affiliation: Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.|Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.|The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.
authors.forename: Tracy
authors.initials: T
authors.lastname: Onega
authors.affiliation: Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.|Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.
authors.forename: Julie E
authors.initials: JE
authors.lastname: Weiss
authors.affiliation: Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Kimberly A
authors.identifier: http://orcid.org/0000-0002-7573-7950
authors.initials: KA
authors.lastname: Harris
authors.affiliation: Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts.|Harvard Medical School, Boston, Massachusetts.|Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Haas
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D007348:Insurance, Health; D008327:Mammography / Q000706:statistics & numerical data; D008484:Medicaid; D006278:Medicare; D008875:Middle Aged; D011320:Primary Health Care; D014481:United States
keywords: Access to care; cancer screening; digital breast tomosynthesis (DBT); digital mammography (DM); health disparities