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HEALTH CARE–Site Aids Search for What Mammogram Overlooks



Health Care: System Helps Spot Cancers

Dr. Larry Chespak, an experienced radiologist-turned Web entrepreneur, long ago developed an eye for X-ray precision.

Yet, he’ll be the first to tell his colleagues and patients that appearances can be deceiving.

“It has been shown that doctors overlook up to 17 percent of breast cancers during routine screening mammography,” Chespak said.

To cut that number, Chespak recently launched a Web site encouraging specifically San Diego doctors and women to send in mammograms for a second computer-aided read.

He said the FDA-approved computerized system, dubbed ImageChecker, was developed by R2 Technology in Los Altos. The system can help detect between 15 and 20 percent of cancers that may have slipped by the radiologist’s eye.

Called iMammogram.com, which made its debut on the Internet on Feb. 8, it charges women $75 per reading. The idea is for women who had their mammogram taken to retrieve it from the medical facility and send it to iMammogram.com for an additional read.

Any abnormalities detected by the computerized system would be marked, then sent back to the imaging center for another interpretation, Chespak said.

All mammograms are digitized and stored at iMammogram.com for future comparisons or sale (at $20 each) in case the image is lost in the medical facility, Chespak said.

Manageable Market Size

Chespak founded iMammogram.com last year.

The Westlake Village-based radiologist has no intention of giving up his private practice, which is comprised of six doctors. To the contrary, he hopes once his idea takes off, he’ll hire a CEO to run iMammogram.com and take it public.

For now, however, Chespak is eyeing San Diego’s doctors and potentially 300,000 customers. That is Chespak’s estimated population of middle-aged and older women in San Diego who should consider breast cancer screenings.

Chespak recently sent letters to 180 San Diego radiologists and 320 gynecologists to spread the word about his company.

“We chose San Diego because of its manageable market size,” Chespak said.

According to his research, most centers providing mammograms can’t afford the ImageChecker’s $189,500 price tag.

Chespak bought the device in hopes that women will see the value of a computerized readout and be willing to pay the extra cost of $75, which is not reimbursed by insurance companies.

Technology Vs. Human Skills

Some critics, however, contend that while the technology has its merits, it may not be superior to a radiologist’s diagnosis.

Dr. Jean Mefferd, medical director of the Scripps Breast Cancer Center in La Jolla, and Dr. Daniel Sullivan, associate director of the biomedical imaging program at the National Cancer Institute in Bethesda, Md., expressed higher confidence in radiologists’ abilities.

“I find it hard to believe a radiologist misses 15 to 17 percent of early stage cancers,” said Mefferd.

“Fifteen to 20 percent (of undetected cancers by radiologists) is an overstatement,” said Sullivan. “Five to 15 percent is closer.”

Kevin Davidge, chief financial officer at R2 Technology, said the percentages are based on a one-year clinical trial of 250,000 patients.

He added, however, that ImageChecker can also mark areas that aren’t cancerous.

“We are not a cancer detector , we are a feature detector,” Davidge said. “The software looks for suspicious features that may be proven to be cancer.”

While the traditional X-ray remains the “gold standard” for detecting breast cancer, it’s also far from perfect. Mefferd estimates that mammography misses about 10 percent of cancers.

Double Checks

“Sometimes a tumor doesn’t make a marker that’s identified on a mammogram,” Mefferd explained. That doesn’t mean radiologists don’t make mistakes, she added.

Sullivan said the chances an experienced radiologist missing a tumor on an X-ray are rare, saying many radiology groups use two sets of eyes to double-check.

“Women should check if the mammogram was double-read. (If it was) there is not much point in sending it in,” he said.

Chespak says that’s not good enough. He said in today’s health care environment, doctors just don’t have the time to scrutinize tests, leaving room for mistakes.

“The number of errors may increase as doctors are forced to read more studies per hour as managed care increases and Medicare reimbursement continues to decrease,” he said.

Chespak, a self-proclaimed avid high-tech supporter, said while computer-aided detection is still in its infancy stage, it’s only a matter of time before it will take off.

More Applications

He believes in the near future, imaging centers will have the proper infrastructure to scan the mammograms themselves and transmit it via broadband technology to iMammogram.com for a second read.

He also foresees other applications for the ImageChecker, such as screening for lung cancer.

But Mefferd said it wouldn’t be worth it to send a mammogram to an outside facility.

“If we were to offer the service, we would buy the scanner (ourselves),” she said.

Mefferd also doesn’t approve of patients removing mammograms from the imaging centers.

“If a woman has to collect her mammogram and send it somewhere she relies on it being sent back,” she said.

In addition, since ImageChecker isn’t perfect either, it can’t rule out a false positive reading, Davidge admitted.

“It takes training to read what the machine is indicating,” he said, adding that without proper training, doctors may be confused in interpreting what they are seeing.

Richard Williams, director of operations, said iMammogram.com will not interpret results. Instead, iMammogram.com plans to send a report back to the imaging center pointing to “regions of interest” on the mammogram.

“We don’t want to provide medical advice,” Williams said.

So far, Chespak has raised $650,000 to get the Westlake Village-based firm off the ground. He anticipates more investors will see the merits of his service.

To boost revenues, Chespak has struck business tie-ins with other Internet-based companies, including Amazon.com.

The cyberspace mega-bookstore offers books on breast cancer at iMammogram.com’s “virtual boutique.”

Under the agreement, iMammogram.com receives 15 percent commission from Amazon.com on every sale, Chespak said.

Other business-to-business relationships with drug makers and pharmacies are in progress, Chespak said.

Additional plans include a chat-room for doctors and a site providing medical information, he said.

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