Hologic, Inc. (Bedford, MA) was founded in 1986 with a bone
densitometer as its first product. Today, the international company
employs nearly 750 people and develops, manufactures, and
distributes a variety of products. The company is very involved in
women's health, and its product lines include osteoporosis
assessment, conventional and digital mammography, breast biopsy,
direct-to-digital X-ray for general radiography applications, and
mini C-arm imaging for orthopedic applications.
In July 2001, Jack W. Cumming was appointed Chief Executive
Officer. He was named Chairman of the Board in November 2002. He
about changing technologies and how they affect women's health
How has the migration to digital changed the practice of
We throw around words like the digital revolution and the migration
to digital with PACS, but it took a long time for some of these
modalities to be totally accepted and to proliferate. Today, PACS
has only penetrated approximately 15% of the market, but it will be
a billion dollar business in the not-too-distant future. Digital
radiography--of which Hologic was a pioneer--and digital
mammography are the last outposts of analog that have now migrated
Through technologic innovation, we're going to find more
cost-effective, better ways to check different disease states. The
interventional pathways will be able to be mapped better with the
use of new contrast agents and new algorithms that allow surgical
planning. As an example, in breast cancer detection, magnetic
resonance (MR) imaging certainly helps in evaluating the
disease--such as where it has spread and the size of it--which
helps to guide surgeons in lumpectomies and other treatment
A digital world, nanotechnology--it's all going to happen. A
decade from now, I think we're going to see some significant
differences. Hopefully it's going to increase the life that you and
How will such technologies help prolong life?
At radiology shows today, you can see 16-slice computed tomography
(CT), the combination of positron-emission tomography (PET) and CT,
and digital mammography. We're migrating. Our Selenia is not a
revolutionary product; it's an evolutionary product. It's obvious
that the world is going to go to digital. With that, I think we are
going to see a big increase in our ability to diagnose. It's the
treatment regimens, the pharmaceuticals, the true bio-markers, the
targeting agents, and cancer drugs that we are going to see; these
are the improvements that are really going to prolong life.
Cardiovascular diseases and cancer are the two leading causes of
death, and that is where people are putting their money in
What is the most important issue in women's imaging today?
I think it's the use of the data. From my perspective--and I'd like
to think I'm speaking for the company--we are firm believers in
developing and designing technology that is screening
With the advent of digital, there has been a big push to
increase reimbursement for digital mammography. Although I favor
increased reimbursement, my focus has been on increasing
reimbursement for screening exams because we need to be able to
serve a broader population of people. Without increased
reimbursement for screening, we are going to find a continual
decrease in the number of mammography centers and a continual
decrease in the number of trained mammographers and technicians who
serve that market.
Other than that, certain enhancements or adjunctive technology
will help to better prioritize decision making because, obviously,
the better road leads to better outcomes. We still have to look at
the number of people in the population and ask, How do we serve
them better? How do we get them involved? How do we educate them to
get imaged on a regular basis so that we can catch this disease
early enough because the survival rates are significantly higher if
What are the benefits of digital versus conventional
From a workflow standpoint, there is no doubt that you can improve
patient throughput. Now, I want to be careful when I say that
because I'm not encouraging institutions to change the way that
they treat their patients. Breast centers, on the whole, have given
patients a lot of TLC because of the high anxiety associated with
this exam. Because of that, if you are going to go from imaging 4
patients an hour to 6 or 8 patients an hour--I think some of our
competitors are saying that you can do 10--the question is, are you
still going to be able to give the kind of TLC to the patients that
earns the reputation of that breast center? That concerns me.
That being said, it will change who the patient interfaces with.
Will they spend more of that TLC time with a different caregiver,
such as a backup technologist? The woman gets to the scanner and
that procedure will take less time because a tech does not have to
go out and see if the images are OK, they are just going to show up
on the screen. You're going to get better patient care just because
there is less wait time, fewer retakes, and the images will be
electronically stored in PACS. At our Selenia workstations, you are
able to view not only the mammogram, but if there is an MRI or an
ultrasound taken of the breast, all of that added information will
be resident on the hospital PACS or the management information
system that we sell as a solution.
The promise of digital is better resolution. In a sense, we've
delivered that. If you look at the Pre-Market Approval (PMA) data
from all the companies, digital has basically shown an equivalency
to film. But the promise has been that it's going to be better than
film, and we believe that Selenia certainly speaks directly to that
Hologic began with bone densitometry. Tell me about the Discovery
The Discovery is also an evolutionary product; it has taken
scanning and interpretation to a new level. We can image the hip or
the spine within 10 seconds. Plus, it has a CT-like design so that
it can perform instant vertebral assessments.
We can do the bone scan in 10 seconds, and then we can do the
scan of the spine in 10 seconds. We have automated analysis tools
including computer-aided detection (CAD) for fracture grading. We
have electronic reporting and full integration capabilities with
hospital information systems. This allows you to streamline the
workflow with what we call OnePass technology. It's a proven
technology platform and a true fan-beam technology.
How does the CAD feature work in fracture grading?
The CAD tools quantify the degree of vertebral compression and
provide the data in a very simple format: the image of the spine
with highlighted areas. It takes the physician right down the spine
at the monitor; it takes each area and indicates whether it is
normal or if it needs further examination. It's either going to
classify the section of spine as normal or as a previous fracture
and, therefore, in need of treatment for osteoporosis. The
physician at that point might decide to perform a CT scan or an MR
study to clearly show the problem area.
How would you get more women to undergo this important
I think it will have to come from the pharmaceutical companies.
They have done a very good job to date, but they need to do a
better job. They're spending tens of millions of dollars to promote
their pharmaceuticals, and in that education process, as part of
their ads, they say, Have you had a bone scan done? What's your
T-score? They are targeting primary care physicians, of course,
because that is who will prescribe their products, especially in
light of the recent negative press on hormone replacement therapy.
With these recent studies, it becomes more important for physicians
to add drug therapy with an agent such as bisphosphonate or
selective estrogen receptor modulator.
Our funds are spent more on the technology side. We have
pamphlets and brochures that the doctors can give to their
patients. We try to work with the pharmaceutical companies and with
the different societies to help promote this. It's very troubling
because I have not seen hospitals go mainstream with this. It's
troubling as the son of a mother who had a hip fracture, not as
somebody who happens to be running a company that manufactures this
I was visiting a customer who had 15 of our mammography systems
and I asked them if they had bone densitometry and they said yes.
So I said, I didn't see it in the women's center. They went around
the room. The first person said, I think it's in endocrinology. The
next person said, No, I think it's in orthopedics, and another
said, No, I think it's now in radiology. I said, Why don't you have
it in the women's center where you do mammography? You have a
captive population there. The majority of patients are
postmenopausal. They are the targets here. If it's a matter of
economics, you get $200 reimbursement. Everybody complains about
mammography and how grossly inadequate reimbursement is--and it is,
especially with centers closing. Yet here you get $200 versus the
approximately $80 you get for screening mammography; and the exam
takes 30 seconds.
Each year 60,000 people die from osteoporosis-related injuries.
It's staggering. The prevalence of breast cancer is so high that it
becomes very personal, but with osteoporosis we just haven't been
able to get it there yet. I wish I had the answer.
What is the company philosophy at Hologic?
One thing that I am very proud of here is that if you go through
our facilities, we have survivors of breast cancer in our
mammography side of the company. We have relatives of people who
haven't survived. They certainly could find jobs closer to their
homes, they might even be able to find jobs that pay them more
money, I don't know. But they are not in it for the number of
systems that we manufacture each month, each year. They're really
in it because they truly believe that they are making a difference
in people's lives with our technology.
If you talk to the people on the bone densitometry side, they
are as passionate as the people on the mammography side. That is
nice to see; that altruism actually works. From a philosophical
standpoint, if the company operates on the basis of trying to
develop and commercialize technologies that make a difference in
people's lives, then the benefits will accrue to them and to their