Mammography AI Can Cost Patients Extra. Is It Worth It?
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As I checked in at a Manhattan radiology clinic for my annual mammogram in November, the front desk staffer reviewing my paperwork asked an unexpected question: Would I like to spend $40 for an artificial intelligence analysis of my mammogram? It’s not covered by insurance, she added.
I had no idea how to evaluate that offer. Feeling upsold, I said no. But it got me thinking: Is this something I should add to my regular screening routine? Is my regular mammogram not accurate enough? If this AI analysis is so great, why doesn’t insurance cover it?
I’m not the only person posing such questions. The mother of a colleague had a similar experience when she went for a mammogram recently at a suburban Baltimore clinic. She was given a pink pamphlet that said: “You Deserve More. More Accuracy. More Confidence. More power with artificial intelligence behind your mammogram.” The price tag was the same: $40. She also declined.
In recent years, AI software that helps radiologists detect problems or diagnose cancer using mammography has been moving into clinical use. The software can store and evaluate large datasets of images and identify patterns and abnormalities that human radiologists might miss. It typically highlights potential problem areas in an image and assesses any likely malignancies. This extra review has enormous potential to improve the detection of suspicious breast masses and lead to earlier diagnoses of breast cancer.
While studies showing better detection rates are extremely encouraging, some radiologists say, more research and evaluation are needed before drawing conclusions about the value of the routine use of these tools in regular clinical practice.
“I see the promise and I hope it will help us,” said Etta Pisano, a radiologist who is chief research officer at the American College of Radiology, a professional group for radiologists. However, “it really is ambiguous at this point whether it will benefit an individual woman,” she said. “We do need more information.”
The radiology clinics that my colleague’s mother and I visited are both part of RadNet, a company with a network of more than 350 imaging centers around the country. RadNet introduced its AI product for mammography in New York and New Jersey last February and has since rolled it out in several other states, according to Gregory Sorensen, the company’s chief science officer.
Sorensen pointed to research the company conducted with 18 radiologists, some of whom were specialists in breast mammography and some of whom were generalists who spent less than 75% of their time reading mammograms. The doctors were asked to find the cancers in 240 images, with and without AI. Every doctor’s performance improved using AI, Sorensen said.
Among all radiologists, “not every doctor is equally good,” Sorensen said. With RadNet’s AI tool, “it’s as if all patients get the benefit of our very top performer.”
But is the tech analysis worth the extra cost to patients? There’s no easy answer.
“Some people are always going to be more anxious about their mammograms, and using AI may give them more reassurance,” said Laura Heacock, a breast imaging specialist at NYU Langone Health’s Perlmutter Cancer Center in New York. The health system has developed AI models and is testing the technology with mammograms but doesn’t yet offer it to patients, she said.
Still, Heacock said, women shouldn’t worry that they need to get an additional AI analysis if it’s offered.
“At the end of the day, you still have an expert breast imager interpreting your mammogram, and that is the standard of care,” she said.
About 1 in 8 women will be diagnosed with breast cancer during their lifetime, and regular screening mammograms are recommended to help identify cancerous tumors early. But mammograms are hardly foolproof: They miss about 20% of breast cancers, according to the National Cancer Institute.
The FDA has authorized roughly two dozen AI products to help detect and diagnose cancer from mammograms. However, there are currently no billing codes radiologists can use to charge health plans for the use of AI to interpret mammograms. Typically, the federal Centers for Medicare & Medicaid Services would introduce new billing codes and private health plans would follow their lead for payment. But that hasn’t happened in this field yet and it’s unclear when or if it will.
CMS didn’t respond to requests for comment.
Thirty-five percent of women who visit a RadNet facility for mammograms pay for the additional AI review, Sorensen said.
Radiology practices don’t handle payment for AI mammography all in the same way.
The practices affiliated with Boston-based Massachusetts General Hospital don’t charge patients for the AI analysis, said Constance Lehman, a professor of radiology at Harvard Medical School who is co-director of the Breast Imaging Research Center at Mass General.
Asking patients to pay “isn’t a model that will support equity,” Lehman said, since only patients who can afford the extra charge will get the enhanced analysis. She said she believes many radiologists would never agree to post a sign listing a charge for AI analysis because it would be off-putting to low-income patients.
Sorensen said RadNet’s goal is to stop charging patients once health plans realize the value of the screening and start paying for it.
Some large trials are underway in the United States, though much of the published research on AI and mammography to date has been done in Europe. There, the standard practice is for two radiologists to read a mammogram, whereas in the States only one radiologist typically evaluates a screening test.
Interim results from the highly regarded MASAI randomized controlled trial of 80,000 women in Sweden found that cancer detection rates were 20% higher in women whose mammograms were read by a radiologist using AI compared with women whose mammograms were read by two radiologists without any AI intervention, which is the standard of care there.
“The MASAI trial was great, but will that generalize to the U.S.? We can’t say,” Lehman said.
In addition, there is a need for “more diverse training and testing sets for AI algorithm development and refinement” across different races and ethnicities, said Christoph Lee, director of the Northwest Screening and Cancer Outcomes Research Enterprise at the University of Washington School of Medicine.
The long shadow of an earlier and largely unsuccessful type of computer-assisted mammography hangs over the adoption of newer AI tools. In the late 1980s and early 1990s, “computer-assisted detection” software promised to improve breast cancer detection. Then the studies started coming in, and the results were often far from encouraging. Using CAD at best provided no benefit, and at worst reduced the accuracy of radiologists’ interpretations, resulting in higher rates of recalls and biopsies.
“CAD was not that sophisticated,” said Robert Smith, senior vice president of early cancer detection science at the American Cancer Society. Artificial intelligence tools today are a whole different ballgame, he said. “You can train the algorithm to pick up things, or it learns on its own.”
Smith said he found it “troubling” that radiologists would charge for the AI analysis.
“There are too many women who can’t afford any out-of-pocket cost” for a mammogram, Smith said. “If we’re not going to increase the number of radiologists we use for mammograms, then these new AI tools are going to be very useful, and I don’t think we can defend charging women extra for them.”
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
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The Seven-Day Sleep Prescription – by Dr. Aric Prather
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You probably already know about sleep hygiene. So, what does this book have to offer?
Dr. Aric Prather offers seven days’ worth of adjustments, practices to take up, from when you get up in the morning to when you lay your head down at night.
Some you’ll surely be familiar with, like avoiding blue light and social media at night.
Others, you might not be familiar with, like scheduling 15 minutes for worrying in the daytime. The rationale for this one is that when you find yourself inclined to worry at a time that will keep you awake, you’ll know that you can put off such thoughts to your scheduled “worrying time”. That they’ll be addressed then, and that you can thus sleep soundly meanwhile.
Where the book really comes into its own is in such things as discussing how to not just manage sleep debt, but how to actually use it in your favour.
Nor does Dr. Prather shy away from the truths of our world… That the world these days is not built for us to sleep well. That there are so many other priorities; to get our work done, to succeed and achieve, to pay bills, to support our kids and partners. That so many of these things make plenty of sense in the moment, but catch up with us eventually.
Bottom line: what this book aims to give is a genuinely sustainable approach to sleeping—controlling what we can, and working with what we can’t. If you’d like to have a better relationship with sleep, this book is an excellent choice.
Click here to check out the Seven-Day Sleep Prescription, and improve yours!
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The Stress-Proof Brain – by Dr. Melanie Greenberg
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The premise of the book is as stated in the subtitle: using mindfulness and neuroplasticity to manage our stress response.
As such, it’s divided into three parts:
- Understanding your stress (and different types of stressors)
- Calming your amygdalae (thus, dealing with your stress response while the stressor is stressing you)
- Moving forward with your prefrontal cortex (and thus, gradually improving automatic stress responses over time, as we learn new, better responses to do automatically)
The content ranges from the neurophysiological to “therapist’s couch” stuff; Dr. Greenberg having her PhD in psychology has prepared her to write both of those different-but-touching fields with equal competence. In-line citations are given throughout, for those who want to look up studies.
The style is direct and informative, with little to no attention given to making it an entertaining read. As a result, it’s information dense (which is good), and/but not necessarily a “couldn’t put it down” page-turner.
Bottom line: if you’d like to improve your ability to deal with stress, this book is as good as any.
Click here to check out The Stress-Proof Brain, and stress-proof yours!
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Self-Compassion In A Relationship (Positives & Pitfalls)
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Practise Self-Compassion In Your Relationship (But Watch Out!)
Let’s make clear up-front: this is not about “…but not too much”.
With that in mind…
Now let’s set the scene: you, a happily-partnered person, have inadvertently erred and upset your partner. They may or may not have already forgiven you, but you are still angry at yourself.
Likely next steps include all or any of:
- continuing to apologise and try to explain
- self-deprecatory diatribes
- self-flagellation, probably not literally but in the sense of “I don’t deserve…” and acting on that feeling
- self-removal, because you don’t want to further inflict your bad self on your partner
As you might guess, these are quite varied in their degree of healthiness:
- apologising is good, as even is explaining, but once it’s done, it’s done; let it go
- self-deprecation is pretty much never useful, let alone healthy
- self-flagellation likewise; it is not only inherently self-destructive, but will likely create an additional problem for your partner too
- self-removal can be good or bad depending on the manner of that removal: there’s a difference between just going cold and distant on your partner, and saying “I’m sorry; this is my fault not yours, I don’t want to take it out on you, so please give me half an hour by myself to regain my composure, and I will come back with love then if that’s ok with you”
About that last: mentioning the specific timeframe e.g. “half an hour” is critical, by the way—don’t leave your partner hanging! And then do also follow through on that; come back with love after the half-hour elapses. We suggest mindfulness meditation in the interim (here’s our guide to how), if you’re not sure what to do to get you there.
To Err Is Human; To Forgive, Healthy (Here’s How To Do It) ← this goes for when the forgiveness in question is for yourself, too—and we do write about that there (and how)!
This is important, by the way; not forgiving yourself can cause more serious issues down the line:
If, by the way, you’re hand-wringing over “but was my apology good enough really, or should I…” then here is how to do it. Basically, do this, and then draw a line under it and consider it done:
The Apology Checklist ← you’ll want to keep a copy of this, perhaps in the notes app on your phone, or a screenshot if you prefer
(the checklist is at the bottom of that page)
The catch
It’s you, you’re the catch 👈👈😎
Ok, that being said, there is actually a catch in the less cheery sense of the word, and it is:
“It is important to be compassionate about one’s occasional failings in a relationship” does not mean “It is healthy to be neglectful of one’s partner’s emotional needs; that’s self-care, looking after #1; let them take care of themself too”
…because that’s simply not being a couple at all.
Think about it this way: the famous airline advice,
“Put on your own oxygen mask before helping others with theirs”
…does not mean “Put on your own oxygen mask and then watch those kids suffocate; it’s everyone for themself”
So, the same goes in relationships too. And, as ever, we have science for this. There was a recent (2024) study, involving hundreds of heterosexual couples aged 18–73, which looked at two things, each measured with a scaled questionnaire:
- Subjective levels of self-compassion
- Subjective levels of relationship satisfaction
For example, questions included asking participants to rate, from 1–5 depending on how much they felt the statements described them, e.g:
In my relationship with my partner, I:
- treat myself kindly when I experience sorrow and suffering.
- accept my faults and weaknesses.
- try to see my mistakes as part of human nature.
- see difficulties as part of every relationship that everyone goes through once.
- try to get a balanced view of the situation when something unpleasant happens.
- try to keep my feelings in balance when something upsets me.
Note: that’s not multiple choice! It’s asking participants to rate each response as applicable or not to them, on a scale of 1–5.
And…
❝Women’s self-compassion was also positively linked with men’s total relationship satisfaction. Thus, men seem to experience overall satisfaction with the relationship when their female partner is self-kind and self-caring in difficult situations.
Unexpectedly, however, we found that men’s relationship-specific self-compassion was negatively associated with women’s fulfillment.
Baker and McNulty (2011) reported that, only for men, a Self-Compassion x Conscientiousness interaction explained whether the positive effects of self-compassion on the relationship emerged, but such an interaction was not found for women.
Highly self-compassionate men who were low in conscientiousness were less motivated than others to remedy interpersonal mistakes in their romantic relationships, and this tendency was in turn related to lower relationship satisfaction❞
~ Dr. Astrid Schütz et al. (2024)
And if you’d like to read the cited older paper from 2011, here it is:
Read in full: Self-compassion and relationship maintenance: the moderating roles of conscientiousness and gender
The take-away here is not: “men should not practice self-compassion”
(rather, they absolutely should)
The take-away is: we must each take responsibility for managing our own mood as best we are able; practice self-forgiveness where applicable and forgive our partner where applicable (and communicate that!)…. And then go consciously back to the mutual care on which the relationship is hopefully founded.
Which doesn’t just mean love-bombing, by the way, it also means listening:
The Problem With Active Listening (And How To Do Better)
To close… We say this often, but we mean it every time: take care!
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Apples vs Dates – Which is Healthier?
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Our Verdict
When comparing apples to dates, we picked the dates.
Why?
Both have their strengths, but ultimatley, it wasn’t close:
In terms of macros, dates have more fiber and carbs, for an approximately equal glycemic index. Thus, we say dates win this category as the more nutritionally dense option.
In the category of vitamins, apples have more of vitamins A, C, and E, while dates have more of vitamins B1, B2, B3, B5, B6, B7, B9, K, and choline. A clear win for dates.
When it comes to minerals, it’s even more one-sided: apples are not richer in any minerals, while dates have a lot more calcium, copper, iron, magnesium, manganese, phosphorus, potassium, selenium, and zinc. An overwhelming win for dates.
Of course, enjoy either or both (diversity is good), but if you want the most nutrients per bite, it’s dates.
Want to learn more?
You might like to read:
From Apples to Bees, and High-Fructose Cs: Which Sugars Are Healthier, And Which Are Just The Same?
Enjoy!
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When Science Brings Hope
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There’s a lot of bad news out there at present, including in the field of healthcare. So as some measure of respite from that, here’s some good news from the world of health science, including some actionable things to do:
Run for your life! Or casually meander for your life; that’s fine too.
Those who enjoy the equivalent of an average of 160mins slow (3mph) walking per day also enjoy the greatest healthspan. Now, there may be an element of two-way causality here (moving more means we live longer, but also, sometimes people move less because of having crippling disabilities, which are themselves not great for healthspan, as well as having the knock-on effect of reducing movement, and so such conditions yield and anti-longevity double-whammy), but for any who are able to, increasing the amount of time per day spend moving, ultimately results (on average) in a lot of extra days in life that we’ll then get to spend moving.
Depending on how active or not you are already, every extra 1 hour walked could add two hours and 49 minutes to life expectancy:
Read in full: Americans over 40 could live extra 5 years if they were all as active as top 25% of population, modeling study suggests
Related: The Doctor Who Wants Us To Exercise Less & Move More
Re-teaching your brain to heal itself
Cancer is often difficult to treat, and brain tumors can be amongst the most difficult with which to contend. Not only is everything in there very delicate, but also it’s the hardest place in the body to get at—not just surgically, but even chemically, because of the blood-brain barrier. To make matters worse, brain tumors such as glioblastoma weaken the function of T-cells (whose job it is to eliminate the cancer) by prolonged exposure.
Research has found a way to restore the responsiveness of these T-cells to immune checkpoint inhibitors, allowing them to go about their cancer-killing activities unimpeded:
Read in full: New possibilities for treating intractable brain tumors unveiled
Related: 5 Ways To Beat Cancer (And Other Diseases)
Here’s to your good health!
GLP-1 receptor agonists, originally developed to fight diabetes and now enjoying popularity as weight loss adjuvants, work in large part by cutting down food cravings by interfering with the chemical messaging about such.
As a bonus, it seems that they also can reduce alcohol cravings, especially by targetting the brain’s reward center; this was based on a large review of studies looking at how GLP-1RA use affects alcohol use, alcohol-related health problems, hospital visits, and brain reactions to alcohol cues:
Read in full: Diabetes medication may be effective in helping people drink less alcohol, research finds
Related: How To Reduce Or Quit Alcohol
Take care!
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Monosodium Glutamate: Sinless Flavor-Enhancer Or Terrible Health Risk?
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What’s The Deal With MSG?
There are a lot of popular beliefs about MSG. Is there a grain of truth, or should we take them with a grain of salt? We’ll leap straight into myth-busting:
MSG is high in salt
True (technically) False (practically)
- MSG is a salt (a monosodium salt of L-glutamic acid), but to call it “full of salt” in practical terms is like calling coffee “full of fruit”. (Coffee beans are botanically fruit)
- It does contain sodium, though which is what the S stands for!
- We talked previously about how MSG’s sodium content is much lower than that of (table) salt. Specifically, it’s about one third of that of sodium chloride (e.g. table salt).
MSG triggers gluten sensitivity
False!
Or at least, because this kind of absolute negative is hard to prove in science, what we can say categorically is: it does not contain gluten. We understand that the similar name can cause that confusion. However:
- Gluten is a protein, found in wheat (and thus wheat-based foods).
- Glutamate is an amino acid, found in protein-rich foods.
- If you’re thinking “but proteins are made from amino acids”, yes, they are, but the foundational amino acid of gluten is glutamine, not glutamate. Different bricks → different house!
The body can’t process MSG correctly
False!
The body has glutamate receptors throughout the gut and nervous system.
The body metabolizes glutamate from MSG just the same as from any other food that contains it naturally.
Read: Update on food safety of monosodium l-glutamate (MSG) ← evidence-based safety review
MSG causes “Chinese Restaurant Syndrome”
False!
Racism causes that. It finds its origins in what was originally intended as a satirical joke, that the papers picked up and ran with, giving it that name in the 1960s. As to why it grew and persisted, that has more to do with US politics (the US has been often at odds with China for a long time) and xenophobia (people distrust immigrants, such as those who opened restaurants), including nationalistic rhetoric associating immigrants with diseases.
Read: Xenophobia in America in the Age of Coronavirus and Beyond ← academic paper that gives quite a compact yet comprehensive overview
Research science, meanwhile, has not found any such correlation, in more than 40 years of looking.
PS: we realize this item in the list is very US-centric. Apologies to our non-US subscribers. We know that this belief isn’t so much of a thing outside the US—though it certainly can crop up elsewhere sometimes, too.
Are there any health risks associated with MSG, then?
Well, as noted, it does contain sodium, albeit much less than table salt. So… do go easy on it, all the same.
Aside from that, the LD50 (a way of measuring toxicity) of MSG is 15.8g/kg, so if for example you weigh 150lb (68 kg), don’t eat 2.2lb (a kilogram) of MSG.
There have been some studies on rats (or in one case, fruit flies) that found high doses of MSG could cause heart problems and/or promote obesity. However:
- this has not been observed to be the case in humans
- those doses were really high, ranging from 1g/kg to 8g/kg. So that’d be the equivalent of our 150lb person eating it by the cupful
- it was injected (as a solution) into the rats, not ingested by them
- so don’t let someone inject you with a cup of MSG!
Read: A review of the alleged health hazards of monosodium glutamate
Bottom line on MSG and health:
Enjoy in moderation, but enjoy if you wish! MSG is just the salt form of the amino acid glutamate, which is found naturally in many foods, including shrimp, seaweed, and tomatoes.
Scientists have spent more than 40 years trying to find health risks for MSG, and will probably keep trying (which is as science should be), but for now… Everything has either come up negative, or has been the result of injecting laboratory animals with megadoses.
If you’d like to try it in your cooking as a low-sodium way to bring out the flavor of your dishes, you can order it online. Cheapest in bulk, but try it and see if you like it first!
(I’ll be real with you… I have 5 kg in the pantry myself and use about half a teaspoon a day, cooking for two)
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