Empowering Women with their Own Breast Health History: Transforming the Experience, Cost and Outcomes of Breast Cancer Screening

Transcription

1 WHITEPAPER Empowering Women with their Own Breast Health History: Transforming the Experience, Cost and Outcomes of Breast Cancer Screening By Kathryn Pearson Peyton, MD September 2018 Introduction 1

2 Statistics show that 1 in 8 women will be diagnosed with breast cancer in her lifetime. This staggering reality is causing more than awareness of the disease; it s changing the expectations of healthcare consumerism as we know it. Women are taking more control of their medical data and looking for the right tools to help them navigate our complex healthcare system. Unfortunately, they often lack the necessary consumer-friendly resources to properly manage their care. This is especially the case for women who need to access their prior mammograms. These exams are necessary for comparisons over time and early breast cancer detection. When these exams are not available, care is often delayed, the patient may be exposed to redundant testing and false positives, or medical decisions are made with only the immediately available information. Our research shows that when these exams are available at the time of screening, there is significant clinical, experiential and economic value created. In short, women need an easily accessible, secure mechanism to request their records digitally from wherever they have received care, upload any records available at home, store them long-term and share them with anyone who needs access. What s Inside Introduction page 3 Why Prior Mammograms Matter page 5 Impact on Providers and Healthcare Quality page Avoidable Costs for Health Plans page 9 Electronic Mammography Exchange Provides Better Outcomes and Better Healthcare page 12 References page Appendix page 16 About Mammosphere page 20 Introduction 2

3 Introduction Seismic demographic and industry shifts are contributing to a new dynamic for consumerism in healthcare where patients expect greater value and a better care experience. Today s healthcare consumers are more mobile than ever and have grown accustomed to nearly instantaneous data sharing in other aspects of their lives. Many American families are covered by a high-deductible plan (HDHP), which forces them to be more aware of the bang they are getting for their buck. While patients are expected to take more control in their care journey and be informed consumers, they often lack the necessary consumer-friendly tools to do so effectively. Patients must still navigate within a healthcare system where data blocking is an entrenched business strategy and physician practices stubbornly cling to old technology such as faxes and compact discs to deliver data to patients. This becomes particularly problematic for patients when you consider that laptops and tablets today typically do not come equipped with disc drives, and the majority of patients do not have easy access to a fax machine. This creates an environment where capturing a patient s medical history, and arming them with their imaging data in a usable format, is an ongoing challenge. Even for patients who remain stationary and receive ongoing care at a single location throughout their lifetime, they are still be left to navigate a complex maze of departments inside a single hospital or health system that do not share records easily. This issue is often a pervasive one; the federal government has begun to recognize the need for patient empowerment to drive interoperability. In April 2018, the Centers for Medicare and Medicaid Services (CMS) announced proposed changes to empower patients and reduce the administrative burden of accessing health records. By putting patients in control, their providers of choice can have real-time access to their medical history in order to properly diagnose and treat in a timely manner. Diagnostic images are a critical component of any medical history. This is especially true for diseases such as breast cancer, which requires regular screening and monitoring of comparison mammograms over time. Unfortunately, the healthcare marketplace has historically lacked a tool that can handle the technical complexities of managing the flow of both medical Introduction 3

4 images and associated clinical information (reports, treatment plans, etc.) from a multitude of locations in a secure and HIPAA-compliant manner, and be readily accessed in a singular place. Too often, patients bear the burden of collecting and couriering their medical records. This typically involves physical trips to each provider holding a part of the record to collect a print out, x-ray, CD, or hundreds of pages of copied records. If additional opinions are needed, the manual process begins again. Women Require a Better Healthcare Experience Sixty million women in the United States get regular mammograms. Because every woman s breast tissue is unique, clinicians must have access to a woman s prior breast health images in order to accurately interpret a mammogram for comparison. When providers have the exams in real-time, the care experience and patient outcomes improve. However, statistics show that at least 1 in 4 women do not have their prior exams available at the time of their mammogram screening. Appendix 2 Because interoperability is lacking, care is often delayed while waiting for information to arrive, the patient is exposed to redundant testing, or medical decisions are made with only the immediately available information. Women need the ability to request their diagnostic quality records digitally from wherever they have received care, store their records and images securely longterm, and share them with anyone who needs access. Having access to this information increases accuracy in early detection of breast cancer and reduces additional, costly imaging and follow-up biopsies, while empowering women to take control of their breast health experience. Introduction 4

5 Why Prior Mammograms Matter Other than skin cancer, breast cancer is the most prevalently diagnosed cancer with the number of cases expected to double by 2030 due to the growing aging population. 1,2 Mammography screening remains the best early detection method for early stage, treatable breast cancer. When breast cancer is detected on a mammogram, it is typically 96-99% curable without significant therapy. 3 Unlike most other types of medical imaging which is episodic, mammography relies heavily on comparisons with prior exam images to determine what is considered normal for each patient versus an early sign of breast cancer. When there is a perceived abnormality in the screening exam, or the provider is unclear due to a lack of comparison exams, the patient is asked to return and is recalled for additional imaging or testing. For approximately 95% of this recalled population, 4, Table 1 the additional exams indicate no cancer. The original reading then becomes a false-positive. The average recall rate for mammography screening in the United States is currently 11.6%, a 19.6% increase from 9.7% in , Table 1 This is high when you consider that the recall rate is consistently between 1-3% 7, 8, Table 2 for certain European countries that provide access to prior mammogram images through a national network. In the United States, approximately 8-25% of the recalled patients are recommended for biopsies; 72.5% of these come back as normal. 4 This means that only 27.5% of these cases are cancerous. As a result, false-positives can have an impact on screening recommendations and reduce patient adoption and adherence to screening guidelines, despite the proven impact on morbidity and mortality rates. Why Prior Mammograms Matter 5

6 Without Prior Mammograms VS. With Prior Mammograms Without Expensive tests False positive and recall rates 260% higher Increased anxiety No benchmark to compare prior exams for better diagnoses and interpretation With Second opinions and consultations are more effective 40-60% fewer false positive findings 25% of cancer found is more treatable Reduced anxiety Less time wasted Why Prior Mammograms Matter 6

7 Impact on Providers and Healthcare Quality Radiologists are under increased pressure to turn around a mammogram result or report faster. Under the federally-mandated Mammography Quality Standards Act (MQSA), patients must receive their mammogram report (aka result) from the provider within thirty days of the exam. 9 But thirty days can feel like an eternity for patients waiting for their results. In some cases, radiologists cannot or do not wait for the arrival of necessary outside prior images, resulting in suboptimal reports with increased radiologist frustration and diminished performance (apparent in BIRADS Medical Audit). 10 Due to the significant interoperability challenges between providers, acquisition of prior images for comparison is a heavy resource burden. Most requested outside prior exams are not available in time for necessary image interpretations, resulting in 30% of exams needing re-interpretation with report addenda (which results in double work for staff and radiologists) when prior outside exams finally trickle in for comparison. 11 Administrative Burden and Financial Impact Hospitals and outpatient imaging centers allocate significant manpower and financial resources chasing down prior patient records, creating and mailing compact discs (CDs), and downloading images from discs into PACS systems. The cost of these activities is estimated to be $20-$30 per patient. 12, 13, 14 As a result, operation costs go up, while diminishing quality and timeliness of care. More traditional methods for image sharing, such as CDs and virtual private networks (VPNs), can also slow delivery of care for breast cancer patients. The problems with CDs include delayed diagnosis and treatment of abnormal mammograms, high costs, and unpredictable reliability. VPNs are difficult due to network security, maintenance, disparate manufacturers, slow network traffic, and limiting costs and IT resources. However, at the National Consortium of Breast Centers Conference in March 2013, it was reported that cloud-based image sharing improves care at breast centers while also reducing costs. 15 A study at the University of California, San Francisco (UCSF) showed that the risk of unnecessary, additional examinations increased 260% when prior mammograms were not available for comparison. 16,17 These high recall rates account for the majority of imaging costs related to breast cancer screening. 18 Impact on Providers and Healthcare Quality 7

8 High recall rates also cause increased anxiety to patients and their family members, which may result in delayed care in the future. It was shown that among those with false-positive results, 22% of these patients delayed their next exam, compared to 15% of those with true-negative results. 19 Timely access to prior exams reduces the incidence of radiologists false-positive mammogram readings by at least half, 12, 20 with the UCSF study demonstrating a 62% reduction in recall rates when multiple prior comparisons are available. 16 Improved Clinical Outcomes with Prior Exams Research shows that access to prior mammograms, preferably with two or more priors, 16 can significantly improve the accuracy of mammography. The chart below gives a breakdown of the impact on specificity and sensitivity when these exams are available at the time of screening. IMPROVED SPECIFICITY Reduced false-positive recall rates of mammography screening by 12,16-17,21-24, Table %. IMPROVED SENSITIVITY For screening exams, the Cancer Detection Rate is 53% higher when prior comparisons are available and more than three times as high for diagnostic exams. 16,25 False-positive recall rate is 260% higher when prior exams are not 16, 17 available 30% of cancers are diagnosed earlier; 10% of cancers more frequently ductal carcinoma in situ (DCIS), meaning the cancer has not spread into the 25, Table 4 surrounding breast tissue. Reduced false-positive biopsy recommendations of diagnostic 12, 17, 20 mammography by 80%. 12% of cancers are detected before becoming metastatic to lymph nodes. 20,25, Table 4 Without priors, diagnosed cancers are lymph node-positive in 45% of patients. 25 Impact on Providers and Healthcare Quality 8

9 Avoidable Costs for Health Plans As more health plans adopt the principles of the Triple AIM, they are becoming increasingly focused on quality improvement and the experience of their members. The lack of access to prior mammograms can negatively affect Triple Aim achievement in the following ways: Causes members anxiety, added expenses, unnecessary tests and procedures, unneeded radiation exposure, as well as time away from work and family Impacts efficacy of cancer screening programs Creates unnecessary spend due to repeat studies, biopsies and late treatment, which ultimately adds up to billions of dollars of medical spend However, when these exams are available to their members, health plans can experience significant savings, particularly with imaging, biopsies and cancer treatments. The Financial Impact of False Positives Below is a step-by-step breakdown of how health plans can calculate the avoidable costs caused by false positives. The calculations are based on recent expenditure data from a major U.S. health care insurance provider. 26 Step 1: Identify the population of recalled women in your member base Using population data, health plans can apply their statistics to determine the number of eligible women undergoing mammograms using the formula below. If a health plan does not have access to this specific data, they can estimate the impacted population using general population statistics. Avoidable Costs for Health Plans 9

10 For example, for a health plan with 1 million members, the screening population would be 163, ,000 women, depending on the mammography utilization rate in their region. Once the screening population is determined, the health plan can then determine the number of unnecessary recalls using the formula below. Using the screening population of 163, ,000 women, 8,150-10,000 would be unnecessarily recalled for additional imaging and possible biopsies, all because of unavailable prior comparison mammograms. Step 2: Calculate avoidable costs for unnecessary imaging and biopsies Using the formula below, health plans can plug in their recalled population to find avoidable costs associated with unnecessary imaging and biopsies. The average cost for a false-positive mammogram is $852 in the twelve months following diagnosis. 26 If a health plan with 1 million members has 8,150-10,000 unnecessary recalls, this equates to a potential of $ M in avoidable costs per year. Avoidable Costs for Health Plans 10

11 Step 3: Calculate the treatment savings for cancers caught earlier when they are more treatable Using the formula below, health plans can then calculate avoidable costs for earlier-diagnosed cancer treatments. The calculated avoided cost for intercepted lymph node-positive cancers is approximately $65,000 per Medicare patient when chemotherapy was not needed for earlier node-negative stage cancers. 28,29 Using the screening population of 163, ,000, this equates to $ $15.6 M in costs avoided for early-diagnosed cancer treatments. Step 4: Calculate Total Avoidable Costs To find the total in avoidable costs for the health plan, add the total avoided costs for unnecessary imaging and biopsies to the total for earlier-diagnosed cancer treatments. Using the examples above, this would equate to $ million in avoidable costs. + Avoidable Costs for Health Plans 11

12 Electronic Mammography Exchange Provides Better Outcomes and Better Healthcare As our research shows, the unnecessary anxiety and additional costs associated with false positives can easily be reduced by simply improving access to prior mammograms. As previously mentioned, a unified access point to these exams is needed for both patients and providers. Mammosphere, a digital patient engagement platform, provides a solution to this problem by offering a secure way for women to access their complete breast health history, including diagnostic quality images of prior mammograms. Mammosphere empowers patients to take control of their health by enabling them to engage in the electronic retrieval, storage, and sharing of their own medical images. Summary of Financial Savings and Improved Outcomes Implementing a mammography image exchange platform like Mammosphere offers multiple opportunities for savings, as well as generated revenue. In summary, our research shows the economic impact to be: $852 $65,000 $20-30 saved for each patient unnecessarily recalled for additional imaging and possible biopsy saved for each patient poorly diagnosed at a later lymph node-positive stage saved for each patient that has prior mammograms readily available Electronic Mammography Exchange Provides Better Outcomes and Better Healthcare 12

13 Without access to a woman s breast health history, the detection and cure of breast cancer is far more complex for the caregiver and also detrimental to goals of population health. The best chance for accurate diagnosis is to have all of these images available to accurately detect the incremental changes that can indicate breast cancer. This also significantly improves patient outcomes. Cancers detected with available and accessible comparison mammograms have more favorable characteristics. 30 Comparison with previous examinations is associated with a significant decrease in the frequency of axillary node metastasis, or decrease rate of the cancer spreading, and the cancer stage for screening mammography. It also helps to improve true-positive findings, resulting in improved detection of malignancy. Electronic Mammography Exchange Provides Better Outcomes and Better Healthcare 13

14 1 Cancer Statistics 2018: Slide Presentation from the American Cancer Society, (slide 2) retrieved 2/24/18. 2 National Cancer Institute - Accessed 2/25/18. 3 SEER Cancer Statistics Review, , Table National Cancer Institute. gov/csr/1975_2012/, Accessed 2/25/18. 4 Sprague BL, Arao RF, Miglioretti DL, Henderson LM, Buist DS, Onega T, Rauscher GH, Lee JM, Tosteson AN, Kerlikowske K, Lehman CD. National Performance Benchmarks for Modern Screening Digital Mammography: Update from the Breast Cancer Surveillance Consortium. Radiology, April 2017; 283:1: Rosenberg RD, Yankaskas BC, Abraham LA, Sickles EA, Lehman CD, Geller BM, Carney PA, Kerlikowske K, Buist DSM, Weaver DL, Barlow WE, Ballard-Barbash R. Performance Benchmarks for Screening Mammography. Radiology; October 2006; 241: National Cancer Institute: Breast Cancer Surveillance Consortium. Performance Measures for 1,960,150 Screening Mammography Examinations from 2002 to 2006 by Time (Months) Since Previous Mammography --- based on BCSC data as of 2009, 12/14/09. 7 Fracheboud J, de Gelder R, Otto SJ, et al. National evaluation of breast cancer screening in the Netherlands Rotterdam, the Netherlands: andelijk Evaluatie Team voor bevolkingsonderzoek naar Borstkanker; Smith-Bindman R, Chu PW, Miglioretti DL, Sickles EA, Blanks R, Ballard-Barbash R, Bobo JK, Lee NC, Wallis MG, Patnick J, Kerlikowske K. Comparison of Screening Mammography in the United States and the United Kingdom. JAMA. 2003;290(16): MQSA Regulations Section 900.2(c)(2), fda.gov. 10 American College of Radiology Breast Imaging Reporting and Data System (BI-RADS), 5th edition. Reston, VA: Mammosphere Pilot Study at University of Florida Health Jacksonville, 2015, document available. 12 Kleit AN, Ruiz JF. False Positive Mammograms and Detection Controlled Estimation. Health Serv Res August; 38(4): ). 13 Bassett LW, Shayestehfar B, Hirbawi I, Obtaining previous mammograms for comparison: usefulness and costs. AJR Am J Roentgenol Nov;163(5): Wilson TE, Nijhawan VK, Helvie MA. Normal mammograms and the practice of obtaining previous mammograms: usefulness and costs. Radiology Mar;198(3): Yee KM. National Consortium of Breast Centers: Cloud-based image sharing enhances breast care. Aunt Minnie.com. March 27, Hayward JH, Ray KM, Wisner DJ, Kornak J, Lin W, Joe BN, Sickles EA. Improving Screening Mammography Outcomes Through Comparison with Multiple Prior Mammograms. AJR 2016;207: Sickles EA. The use of breast imaging to screen women at high risk for cancer. Radiol Clin North Am 48 (2010) Poplack SP, Carney PA, Weiss JE, Titus-Erstoff L, Goodrich ME, Tosteson ANA. Screening Mammography: Costs and Use of Screening-related Services. Radiology 2005: 234 (1); Dabbous FM, Dolecek TA, Berbaum ML, Friedewald SM, Summerfelt WT, Hoskins K and Rauscher GH. Impact of a False-Positive Screening Mammogram on Subsequent Screening Behavior and Stage at Breast Cancer Diagnosis. Cancer Epidemiol Biomarkers Prev 26 (3), Feb 9 20 Burnside E, Sickles E, Sohlich R, Dee K. The differential value of comparison with previous examinations in diagnostic versus screening mammography. American Journal of Roentgenology. 2002;179: Yankaskas BC, May RC, Matuszewski J, Bowling JM, Jarman MP, Schroeder BF. Effect of Observing Change from Comparison Mammograms on Performance of Screening Mammography in a Large Community-based Population. Radiology 2011; 261 (3); Roelofs AA, Karssemeijer N, Wedekind N, et al. Importance of comparison of current and prior mammograms in breast cancer screening. Radiology Jan;242(1):70-7. References 14

15 23 Thurfjell MG, Vitak B, Azevedo E, Svane G, Thurfjell E. Effects on sensitivity and specificity of mammography screening with or without comparison of old mammograms. Acta Radiol 2000; 41: Sickles EA. Successful methods to reduce false positive mammography interpretations. Radiol Clin North Am 2000; 38(4): ; 25 Data were obtained from the NCI-funded Breast Cancer Surveillance Consortium (HHSN C). Downloaded on 2/18/20 from the Breast Cancer Surveillance Consortium website, Data Explorer Tool: 26 Ong MS and Mandl KD. National Expenditure For False-Positive Mammograms And Breast Cancer Overdiagnoses Estimated At $4 Billion A Year. Health Affairs 34: 4 (2015): ACS Breast Cancer Facts & Figures P. 23. Retrieved 2/20/18. research/cancer-facts-statistics/breast-cancer-facts-figures.html. 28 Groot MT, Baltussen R, Uyl-de Groot CA, et al. Costs and Health Effects of Breast Cancer Interventions in Epidemiologically Different Regions of Africa, North America, and AsiaThe Breast Journal, Volume 12 Suppl. 1, 2006 S81-S Taylor DCA, Sanon M, Clements K, et al. Treatment pattern and costs following metastatic breast cancer diagnosis in U.S. women: a SEER-Medicare Analysis. J Clin Oncol. 2011; abstract Taylor DCA, Sanon M, Clements K, et al. Treatment pattern and costs following metastatic breast cancer diagnosis in U.S. women: a SEER-Medicare Analysis. J Clin Oncol. 2011; abstract 150. References 15

16 Appendix: Average Patient Population Presenting Without Prior Exams 23, 17, 12, 13 25% of the average patient population presents for a screening exam without available prior comparisons available. Priors are then requested (staff & mailing costs). Interpretation is delayed up to 2 weeks waiting for receipt and PACS computer ingestion of outside prior CDs (20% discs are locked or broken). - Breast Cancer Surveillance Consortium: 31.6% patients (428,140 patients from total 1,356,315) were interpreted without previous mammograms (data ) University of California at San Francisco: 33% of their 140,544 patients presented without previous mammograms, with 60% requests for priors unsuccessful even after waiting 2 weeks (2010) Health Services Research: 14% of their screening patients (5000 patients) presented without priors; 60% of their diagnostic patients (3363 patients) presented without priors (2003) Carolina Registry: 7% of screening patients (435,183 women) interpreted without priors (12% of women ages 40-49), but the study does not report on patients presenting without priors available, nor results of requesting (% receiving) and time waiting for receipt of priors for initial and final image interpretation (2011) Roelofs: Priors requested in 24-33% of cases (2007). - Burnside: 17% of screening exams (48241 mammograms) interpreted without priors after waiting 2 weeks (2002). - Bassett: 22% of women (1432 mammograms) presented without priors available at time of the examination (1994). 13 Time Since Last Imaging Examination (Women) Breast Cancer Surveillance Consortium, ,045 records not counted due to missing information in specified fields Breast Cancer Surveillance Consortium, Among all women. Uses the earliest imaging examination in the BCSC for each woman. 400,000 Frequency 300, , , to 18 months <9 months No previous mammogram 43+ months 31 to 42 months 19 to 30 months Time since last exam Appendix 16

17 Tables Table 1: Recall Rates (Breast Cancer Surveillance Consortium, 2017 and 2006) Sprague BL, et al. Radiology, April 2017; 283:1: Appendix 17

18 Compare to previous 2006 BCSC figure: Trend toward increasing recall nationally Author s Comments: Smoothed plots of frequency distributions for recall rates and PPVs. Overlaid solid line indicates 50th percentile (median), paired dashed lines indicate 25th and 75th percentiles, and paired dotted lines indicate 10th and 90th percentiles. Rosenberg RD et al. Radiology 2006; 241: /14/09. Appendix 18

19 Table 2: Recall rates for initial and subsequent screening mammograms (Breast Cancer Surveillance Consortium (BCSC), National Breast Cancer and Cervical Cancer Early Detection Program (NBCCEDP) & National Health Service Breast Screening Program (NHSBSP)). Author s Comments: The United Kingdom (National Health Service Breast Screening Program) screening mammography recalls are only 3.6% when priors are available, and 200% higher (7.4%) when first screening Baseline exam. As national rates of recall are reported at 3%, this reflects that ALL PRIOR exams are available for comparison, unless baseline. JAMA. 2003; 290(16): Table 3: Improved Accuracy of Screening with Comparisons Positive Predictive Value Level I (PPVI) of Screening Mammograms Interpreted by Comparison With a Single Prior Examination Versus Two or More Prior Examinations Appendix 19

20 Cancer Detection Rate (CDR) for Screening Mammograms Interpreted by Comparison With a Single Prior Examination Versus Two or More Prior Examinations Hayward JH, et al. AJR 2016;207: Table 4: Cancer Characteristics, With and Without Comparison With Previous Examinations, for Screening and Diagnostic Mammography (University of California at San Francisco and Breast Cancer Surveillance Consortium) Note. Numbers in parentheses are percentages, calculated by dividing number of designated cases by total number of cancers. a Determined only for patients with invasive cancer. b Most patients with ductal carcinoma in situ, and a few patients with small low-grade invasive cancer, did not undergo axillary node sampling or sentinel node biopsy because probability of nodal metastasis was judged to be extremely low. Burnside ES, American Journal of Roentgenology. 2002; 179: Time Since Last Imaging Examination by Tumor Stage Breast Cancer Surveillance Consortium, ,827 records not counted due to missing information in specified fields Breast Cancer Surveillance Consortium, First breast cancer in BCSC database. About a third of the women with breast cancer do not have an imaging examination associated with the diagnosis in BCSC. Staging according to AJCC v 6. Appendix 20

21 Comments: BCSC: 51,451 cancers diagnosed from mammography registries data between Of the 7.5% of diagnosed cancers read without priors, 65% had Stage II-IV Of the 92.5% of diagnosed cancers read with priors, 35% had Stage II-IV. This means that when prior comparisons are available, cancers are diagnosed at earlier stage 0 or I with an absolute reduction of 30% in later Stage II-IV cancers. Only 35% of cancers diagnosed without prior comparisons were diagnosed Stage 0 / I. 65% of cancers diagnosed with prior comparisons available were diagnosed Stage 0 / I. Time Since Last Imaging Examination by Lymph Node Status Breast Cancer Surveillance Consortium, ,389 records not counted due to missing information in specified fields Breast Cancer Surveillance Consortium, First breast cancer in BCSC database. About a third of the women with breast cancer do not have an imaging examination associated with the diagnosis in BCSC. Refers to time since the imaging examination before the most recent examination before diagnosis for each woman who was diagnosed with breast cancer. Comments: BCSC: Of all 54,890 cancers, 25.4% were lymph node positive. Data between If no previous comparison mammogram, cancers detected were Lymph Node Positive in 45% of patients. If comparison with previous mammograms, cancers detected were Lymph Node Positive in 19-37%, depending on length of the interval with previous mammogram, increasing with longer interval between mammograms. Therefore, by providing comparisons, LN+ are reduced by an absolute value of 8-26%. Appendix 21

22 About Mammosphere Mammosphere is a digital platform that empowers women to take control of their breast health. It allows patients to request, store and share their complete breast health information, including diagnostic quality images and prior mammograms, digitally and securely. This saves the patient time, money and unnecessary stress while allowing physicians easy access to the critical clinical information they need to make an accurate, timely diagnosis. By reducing waste in the screening and diagnosis process, healthcare payers can achieve tremendous economic savings while improving the quality of care delivered to their members. Payers, providers, and employers are able to offer the digital platform to plan members, patients and employees as part of their population health improvement strategy. Mammosphere is powered by Life Image, the leading medical information network in the country that connects more than 1,500 hospital facilities and more than 150,000 providers. One Gateway Center 300 Washington St, Suite 200 Newton, MA Tel: Fax: mammosphere.com About the author Kathryn Pearson Peyton, MD, is a dedicated and passionate breast-imaging radiologist whose family has had three generations affected by breast cancer. She attended Stanford University, followed by medical school, radiology residency and breast imaging fellowship at the University of California San Francisco. She practiced high-volume breast imaging in San Francisco and Jacksonville, Florida for 15 years. In 2012, she retired from her radiology practice and founded Mammosphere, Inc., to enable immediate patient and physician access to essential prior mammograms and other breast exams. Mammosphere became part of Life Image in Mammosphere. All rights reserved. References 22