Breast Cancer Imaging South America Analysis and Market Forecasts GDME1036CFR / Published May 2013 Executive Summary Breast Cancer Imaging: Key Metrics in South American* markets 2011 Market Sales Brazil $42m Key Features of the Report Number of imaging techniques covered 17 Number of marketed products analyzed 51 Competitors profiled 17 Key Events (2011–2018) Level of Impact Results of the Oslo Breast Cancer Screening Trial ↑↑↑↑ Results of the TOMMY trial ↑↑↑↑ Food and Drug Administration (FDA) approval of GE Healthcare and Siemens Healthcare tomosynthesis systems ↑↑ GlobalData calculated the South American (Brazil) breast cancer imaging market to be worth $42m in 2011 and estimates that it will be worth $71m in 2018, increasing at a Compound Annual Growth Rate (CAGR) of 8% during this time period. The key drivers for the South American breast cancer imaging market are: Increase in the incidence of breast cancer Increased awareness of the benefits of screening Increased breast cancer incidence due to an aging population 2018 Market Sales Brazil Source: GlobalData, 2013 $71m FDA reclassification of mammography equipment New technologies to drive growth in the market Adoption of digital mammography units in South South America = Brazil breast cancer imaging market America The key barriers for the South American breast cancer imaging market are: A shortage of dedicated breast radiologists High capital Investment for full-field digital mammography (FFDM) and tomosynthesis in the face of reduced hospital budgets © GlobalData. This report is a licensed product and is not to be copied, reproduced, shared or resold in any form. Page 2 Refurbished equipment sales Reimbursement issues GDME1036CFR / Published MAY 2013 Executive Summary Significant Unmet Needs and Challenges for the In Brazil, FFDM systemswill continue to grow rapidly with South American Breast Cancer Imaging Market a Even though the South American breast cancer imaging market is a mature one, it has significant needs that still have not been met. Some of these include exposure to ionizing radiation during mammographic examinations, patient discomfort due to compression of the breasts, unreliable mammograms in breasts that have been operated on and breasts with implants, a high number of modest uptake in tomosynthesis, since digital mammography has yet to be widely adopted in these regions and the breast cancer incidence is rising steadily. What do Physicians Think? Radiologists feel that mammography is not an ideal tool for breast screening and there are significant unmet needs. of ‘’Mammography is a useful tool, but it’s a bad technique.’’ mammography sensitivity in dense breasts, and limited Key Opinion Leader, January 2013 false-positives training and provided to false-negatives, technicians by loss equipment manufacturers. A few of these unmet needs are being addressed to a certain extent by using modalities such as ultrasound imaging and magnetic resonance imaging ‘’The biggest challenge [is] to have… patient comfort…[during]…mammography, that’s number one, I think’’ (MRI) in conjunction with mammography. However, there Key Opinion Leader, January 2013 is a still a lot of room for improvement within the market, Radiologists feel strongly that tomosynthesis is very and new technologies currently in development that promising overcome these drawbacks show promise for the future. mammography, the current paradigm. Future Landscape ‘’Mammography is a useful tool, but it’s a bad technique.’’ and will The South American breast cancer imaging market is primarily driven by the increasing incidence of breast cancer. It is also fueled by the need to overcome the drawbacks posed by film – screen mammography, which is the most widely used technique for breast cancer most likely replace digital Key Opinion Leader, January 2013 ‘’I think there is space for everything...but the word is digital, the word is 3D….[The] breast is a 3D organ. Why should we look at [it] in 2D images?” detection and diagnosis in this region. GlobalData Key Opinion Leader, January 2013 anticipates that newer technologies, such as digital ‘’If it’s [tomosynthesis] going to find more cancers and mammography and tomosynthesis, will drive the future fewer recalls, then it should be a win-win.’’ growth of this market. Tomosynthesis is predicted to be Key Opinion Leader, December 2012 the new gold standard in the near future, with high adoption is western countries, including the US, due to its ‘’I’ll tell you today that I am 95% sure that tomosynthesis promising increase in cancer detection and reduction of is false-positives, mammography is gone.’’ which are key mammography. © GlobalData. This report is a licensed product and is not to be copied, reproduced, shared or resold in any form. Page 3 concerns with mammography’s future and conventional Key Opinion Leader, January 2013 GDME1036CFR / Published MAY 2013 Executive Summary ‘’If I have to put money in something, I will put it in Radiologists feel that there is not enough commitment tomosynthesis and MRI [in the] short term [and in the] from the manufacturers towards technician training. long term, maybe….. molecular imaging techniques.’’ ‘’A banker can buy a machine much faster than anyone Key Opinion Leader, January 2013 Radiologists feel that the impact of tomosynthesis out there, right? But I mean the banker cannot get a good image.’’ compared with digital mammography is much greater in Key Opinion Leader, January 2013 comparison to the change from analog to digital ‘’Training is needed because if the technician has not mammography. given good positioning, whatever good factors may be ‘’The change from analog to digital mammography [in the there, good equipment may be there, you won’t be able US], went so fast, so quickly.…amazing, now almost 90% to see things.’’ [adoption]....If you look at the FDA site…90% [adoption], I Key Opinion Leader, December 2012 mean it is incredible. So, what my way of thought is, I say, look if from analog to digital , it was not such a big Radiologists feel that in the future, they foresee more deal, by that I mean it was the same technology, only emphasis being placed on lowering radiation dose. digital The difference was not so big [so only small “[On future market trends] there is going to be more improvement]…, like it is from mammography to emphasis on low [radiation] dose, understanding breast tomosynthesis. You are talking about [image] slices; you density, and being efficient…doing more with less.’’ are talking about 3D [imaging] [so large improvement]….I think, the gain between digital [2D FFDM] Key Opinion Leader, December 2012 and tomo[synthesis] is much, much, much higher than it was ’If there is a good product which does good imaging and from analog to digital.’ it has low [radiation] dose and it’s reliable, then it may be of value.’’ Key Opinion Leader, January 2013 Key Opinion Leader, December 2012 © GlobalData. 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Page 4 GDME1036CFR / Published MAY 2013 Table of Contents 1 Table of Contents 1 Table of Contents ............................................................................................................... 5 1.1 List of Tables .......................................................................................................... 13 1.2 List of Figures ......................................................................................................... 18 2 Introduction....................................................................................................................... 21 2.1 Catalyst .................................................................................................................. 21 3 Disease Overview ............................................................................................................. 22 3.1 Anatomy & Physiology of the Breast ....................................................................... 22 3.2 Pathophysiology of Breast Cancer .......................................................................... 23 3.3 Detection of Breast Cancer ..................................................................................... 23 3.4 Types of Breast Cancer .......................................................................................... 24 3.5 Clinical Presentation ............................................................................................... 26 3.6 Clinical Outcomes ................................................................................................... 27 3.6.1 Assessment Procedure ....................................................................................... 27 3.6.2 Screening Guidelines .......................................................................................... 30 3.7 Epidemiology of Breast Cancer ............................................................................... 31 3.8 Economic Impact of Breast Cancer Imaging ............................................................ 33 4 Imaging Techniques.......................................................................................................... 34 4.1 Mammography........................................................................................................ 34 4.1.1 Overview............................................................................................................. 34 4.1.2 Types of Mammography...................................................................................... 36 4.2 Non-Mammographic Techniques ............................................................................ 41 4.2.1 Breast Ultrasound Imaging .................................................................................. 41 4.2.2 Breast Magnetic Resonance Imaging .................................................................. 42 4.3 Comparison of Mammography, Ultrasound, and MRI .............................................. 43 4.4 Alternative Breast Imaging Techniques ................................................................... 44 4.4.1 Nuclear Imaging Techniques ............................................................................... 45 4.4.2 Computed Tomography....................................................................................... 46 © GlobalData. 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Page 5 GDME1036CFR / Published MAY 2013 Table of Contents 4.4.3 Optical Breast Imaging ........................................................................................ 47 4.4.4 Electric Impedance-Based Techniques................................................................ 47 4.4.5 Thermography .................................................................................................... 48 4.4.6 Elastography ....................................................................................................... 48 4.4.7 Ductogram .......................................................................................................... 48 5 Competitive Assessment................................................................................................... 49 5.1 Overview ................................................................................................................ 49 5.2 Film Screen Mammography .................................................................................... 50 5.2.1 Performa (GE Healthcare)................................................................................... 50 5.2.2 Alpha RT/Alpha ST (GE Healthcare) ................................................................... 53 5.2.3 MAMMOMAT 1000 (Siemens Healthcare) ........................................................... 56 5.2.4 MAMMOMAT 3000 Nova (Siemens Healthcare).................................................. 58 5.2.5 M-IV/M-IV Platinum (Hologic) .............................................................................. 60 5.2.6 MammoDiagnost (Philips Healthcare).................................................................. 62 5.2.7 Planmed Nuance Classic (Planmed) ................................................................... 64 5.2.8 Planmed Sophie Classic (Planmed) .................................................................... 66 5.2.9 Analog Giotto Image (Internazionale Medico Scientifica) ..................................... 68 5.2.10 HAWK-2M (Hologic) ............................................................................................ 70 5.2.11 MGU-1000A (Toshiba Medical Systems) ............................................................. 72 5.3 CR Mammography.................................................................................................. 74 5.3.1 Fuji Computed Radiography Mammography Suite (FCRMS) (Fujifilm Medical Systems) ........................................................................................................... 74 5.3.2 KODAK DirectView (Carestream Health) ............................................................. 77 5.3.3 Xpress CR System (Konica Minolta).................................................................... 79 5.3.4 REGIUS PureView (Konica Minolta) .................................................................... 81 5.3.5 Agfa CR Mammography Systems (DX-M, CR 30-Xm, and CR 85-X) (Agfa Healthcare) ........................................................................................................ 83 5.4 Full-Field Digital Mammography .............................................................................. 85 5.4.1 Selenia Dimensions (Hologic).............................................................................. 86 © GlobalData. 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Page 6 GDME1036CFR / Published MAY 2013 Table of Contents 5.4.2 Selenia (Hologic)................................................................................................. 89 5.4.3 Selenia S (Hologic) ............................................................................................. 91 5.4.4 Selenia Performance (Hologic) ............................................................................ 93 5.4.5 Senographe DS (GE Healthcare) ........................................................................ 95 5.4.6 Senographe Essential (GE Healthcare) ............................................................... 97 5.4.7 Senographe Care (GE Healthcare).................................................................... 100 5.4.8 SenoBright CESM (GE Healthcare) ................................................................... 102 5.4.9 MAMMOMAT Inspiration (Siemens Healthcare)................................................. 104 5.4.10 Aspire HD (US)/Amulet (Outside the US) (Fujifilm) ............................................ 106 5.4.11 MammoDiagnost DR (Philips Healthcare).......................................................... 108 5.4.12 MicroDose (Philips Healthcare) ......................................................................... 110 5.4.13 Giotto Image 3D/3DL (Internazionale Medico Scientifica) .................................. 112 5.4.14 Planmed Nuance/Nuance Excel (Planmed) ....................................................... 114 5.4.15 Fairy DR (Allengers Medical Systems) .............................................................. 116 5.4.16 Serenity ............................................................................................................ 118 5.5 3D Mammography ................................................................................................ 120 5.5.1 Selenia Dimensions 3D System (Hologic).......................................................... 120 5.5.2 GE Breast Tomosynthesis (GE Healthcare) ....................................................... 122 5.5.3 True 3D Breast Tomosynthesis (Siemens Healthcare)....................................... 124 5.5.4 Giotto Tomo (Internazionale Medico Scientifica) ................................................ 126 5.5.5 FUJIFILM 3Dimensional Mammography (Fujifilm) ............................................. 128 5.6 Breast Ultrasound Imaging.................................................................................... 130 5.6.1 somo.v Automated Breast Ultrasound (ABUS) (GE Healthcare)......................... 130 5.6.2 SonoCine AWBUS (SonoCine).......................................................................... 132 5.6.3 ACUSON S2000 ABVS (Siemens Healthcare) .................................................. 134 5.6.4 Terason t3200 Ultrasound System Breast Series (Terason Ultrasound) ............. 136 5.7 Breast MRI ........................................................................................................... 138 5.7.1 Aurora 1.5T Dedicated Breast MRI System (Aurora Imaging Technology) ......... 138 © GlobalData. 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Page 7 GDME1036CFR / Published MAY 2013 Table of Contents 5.8 Other Breast Imaging Techniques ......................................................................... 140 5.8.1 PEM Flex Solo II (Naviscan).............................................................................. 140 5.8.2 Computerized Tomography Laser Mammography (CTLM) Model 1020 (Imaging Diagnostic Systems) ........................................................................................ 142 5.8.3 Dilon 6800/Dilon 6800 Acella (Dilon Diagnostics) .............................................. 144 5.8.4 LumaGEM (Gamma Medica)............................................................................. 146 5.8.5 Discovery NM 750b (GE Healthcare)................................................................. 148 6 Unmet Needs.................................................................................................................. 150 6.1 Lower Radiation Dose........................................................................................... 150 6.2 Increase Patient Comfort ...................................................................................... 152 6.3 Reduce False-Positives and False-Negatives........................................................ 154 6.4 Loss of Sensitivity of Mammography in Dense Breasts.......................................... 156 6.5 Unreliable Mammograms in Surgically-Operated Breasts and Breasts with Implants 158 6.6 Commitment to Training ........................................................................................ 159 7 Pipeline Products ............................................................................................................ 162 7.1 Breast Cancer Imaging Pipeline Products Overview .............................................. 162 7.2 MAMMOMAT Inspiration PRIME Edition ............................................................... 163 7.2.1 Overview........................................................................................................... 163 7.2.2 SWOT Analysis................................................................................................. 163 7.3 MicroDose SI ........................................................................................................ 164 7.3.1 Overview........................................................................................................... 164 7.3.2 SWOT Analysis................................................................................................. 164 7.4 Selenia Dimensions 2D Contrast-Enhanced Digital Mammography (CEDM).......... 165 7.4.1 Overview........................................................................................................... 165 7.4.2 SWOT Analysis................................................................................................. 165 7.5 SenoCase............................................................................................................. 166 7.5.1 Overview........................................................................................................... 166 7.5.2 SWOT Analysis................................................................................................. 167 © GlobalData. 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Page 8 GDME1036CFR / Published MAY 2013 Table of Contents 7.6 Electrical Mammogram ......................................................................................... 168 7.6.1 Overview........................................................................................................... 168 7.6.2 SWOT Analysis................................................................................................. 168 8 Industry Overview ........................................................................................................... 169 8.1 Purchasing Cycle .................................................................................................. 169 8.1.1 Product Life Cycle ............................................................................................. 169 8.1.2 Cost Effectiveness in Screening Settings........................................................... 171 8.1.3 Cost-Effectiveness in Diagnostic Settings .......................................................... 171 8.2 Market Access ...................................................................................................... 172 8.2.1 Purchasing Decisions........................................................................................ 172 8.2.2 Regulatory Process ........................................................................................... 172 8.3 Quality Assurance ................................................................................................. 173 8.4 Adoption of New Technologies.............................................................................. 174 8.4.1 Influence of Clinical Trials Results ..................................................................... 174 8.4.2 Reimbursement................................................................................................. 175 8.4.3 Economic Resources ........................................................................................ 175 8.4.4 Competitive Advantage ..................................................................................... 176 8.5 Current Reimbursement Trends ............................................................................ 176 8.6 Trends in Detector Technology for Digital Mammography...................................... 177 8.7 Evolving Scatter-Removal Mechanisms ................................................................ 181 8.8 Overdiagnosis....................................................................................................... 183 8.9 Malpractice Litigations .......................................................................................... 184 8.10 Mergers and Acquisitions/Key Partnerships .......................................................... 185 8.10.1 GE Healthcare Acquires U-Systems .................................................................. 185 8.10.2 Koninklijke Philips Electronics Acquires MicroDose Mammography from Sectra 185 8.10.3 Hologic Acquires Beijing Healthcome Technology ............................................. 185 8.10.4 Hologic Acquires Sentinelle Medical .................................................................. 185 8.10.5 Koninklijke Philips Electronics Acquires Shanghai Apex Electronics Technology186 © GlobalData. 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Page 9 GDME1036CFR / Published MAY 2013 Table of Contents 8.10.6 Fujifilm Medical Systems acquired FUJIFILM-RU .............................................. 186 8.10.7 Other Key Events .............................................................................................. 186 9 Current and Future Players ............................................................................................. 187 9.1 Overview .............................................................................................................. 187 9.2 Trends in Corporate Strategy ................................................................................ 188 9.3 Company Profiles ................................................................................................. 189 9.3.1 GE Healthcare .................................................................................................. 189 9.3.2 Hologic ............................................................................................................. 191 9.3.3 Siemens............................................................................................................ 193 9.3.4 Koninklijke Philips Electronics ........................................................................... 194 9.3.5 Fujifilm Medical Systems ................................................................................... 196 9.3.6 Internazionale Medico Scientifica (IMS) ............................................................. 197 9.3.7 Planmed ........................................................................................................... 198 9.3.8 Konica Minolta Medical Imaging ........................................................................ 199 9.3.9 Agfa Healthcare ................................................................................................ 200 9.3.10 Carestream Health ............................................................................................ 201 9.3.11 SonoCine .......................................................................................................... 202 9.3.12 Aurora Imaging Technology .............................................................................. 203 9.3.13 Imaging Diagnostic Systems ............................................................................. 204 9.3.14 Naviscan ........................................................................................................... 206 9.3.15 Dilon Diagnostics .............................................................................................. 207 9.3.16 Gamma Medica................................................................................................. 208 9.3.17 Allengers Medical Systems ............................................................................... 209 10 Market Drivers & Opportunities ....................................................................................... 210 10.1 Market Drivers ...................................................................................................... 210 10.1.1 Increase in the Incidence of Breast Cancer ....................................................... 210 10.1.2 Increased Awareness of the Benefits of Screening ............................................ 210 10.1.3 Increased Breast Cancer Incidence Due to an Aging Population........................ 210 © GlobalData. 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Page 10 GDME1036CFR / Published MAY 2013 Table of Contents 10.1.4 FDA Reclassification of Mammography Equipment ........................................... 211 10.1.5 New Technologies to Drive Market Growth ........................................................ 211 10.1.6 Adoption of Digital Mammography Units in South America ................................ 212 10.2 Opportunities ........................................................................................................ 215 10.2.1 Emerging Economies Promise Future Growth ................................................... 215 10.2.2 Invest in Emerging Technologies....................................................................... 216 10.2.3 Product Improvement ........................................................................................ 217 10.3 Market Barriers ..................................................................................................... 218 10.3.1 Shortage of Dedicated Mammography Professionals......................................... 218 10.3.2 Reduced Hospital Budgets ................................................................................ 218 10.3.3 Refurbished Equipment Sales ........................................................................... 219 10.3.4 Reimbursement................................................................................................. 220 10.3.5 Substitutes ........................................................................................................ 220 11 Country Outlooks & Forecasts ........................................................................................ 221 11.1 Brazil .................................................................................................................... 221 11.1.1 Brazil Market Analysis ....................................................................................... 221 12 Appendix ........................................................................................................................ 222 12.1 Bibliography.......................................................................................................... 222 12.2 Abbreviations ........................................................................................................ 248 12.3 Report Methodology.............................................................................................. 253 12.3.1 Overview........................................................................................................... 253 12.3.2 Coverage .......................................................................................................... 253 12.3.3 Secondary Research ......................................................................................... 253 12.3.4 Forecast Methodology....................................................................................... 254 12.4 Physicians and Specialists Included in this Study .................................................. 255 12.5 Primary Research ................................................................................................. 256 12.6 Physician Survey .................................................................................................. 256 12.7 About the Authors ................................................................................................. 257 © GlobalData. 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Page 11 GDME1036CFR / Published MAY 2013 Table of Contents 12.7.1 Analysts ............................................................................................................ 257 12.7.2 Global Head of Healthcare ................................................................................ 258 12.8 Definitions............................................................................................................. 259 12.9 About MediPoint ................................................................................................... 260 12.10 About GlobalData ................................................................................................. 260 12.11 Contact Us............................................................................................................ 260 12.12 Disclaimer............................................................................................................. 261 © GlobalData. 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Page 12 GDME1036CFR / Published MAY 2013 Table of Contents 1.1 List of Tables Table 1: Breast Cancer Types, Including Diagnostic Procedures....................................... 25 Table 2: ACR Breast Imaging Reporting and Database System (BI-RADS) ....................... 27 Table 3: Breast Cancer Incidence Rates in Brazil, 2002 .................................................... 31 Table 4: Comparison of Mammography, Ultrasound, and MRI for Breast Imaging ............. 43 Table 5: Performa Product Profile ..................................................................................... 51 Table 6: Performa SWOT Analysis ................................................................................... 52 Table 7: Alpha RT/Alpha ST Product Profile...................................................................... 54 Table 8: Alpha RT/Alpha ST SWOT Analysis .................................................................... 55 Table 9: MAMMOMAT 1000 Product Profile...................................................................... 56 Table 10: MAMMOMAT 1000 SWOT Analysis .................................................................... 57 Table 11: MAMMOMAT 3000 Nova Product Profile............................................................. 59 Table 12: MAMMOMAT 3000 Nova SWOT Analysis ........................................................... 59 Table 13: M-IV/M-IV Platinum Product Profile ..................................................................... 61 Table 14: M-IV/M-IV Platinum SWOT Analysis.................................................................... 61 Table 15: MammoDiagnost Product Profile ......................................................................... 63 Table 16: MammoDiagnost SWOT Analysis........................................................................ 63 Table 17: Planmed Nuance Classic Product Profile............................................................. 65 Table 18: Planmed Nuance Classic SWOT Analysis ........................................................... 65 Table 19: Planmed Sophie Classic Product Profile.............................................................. 66 Table 20: Planmed Sophie Classic SWOT Analysis ............................................................ 67 Table 21: Analog Giotto Image Product Profile.................................................................... 69 Table 22: Analog Giotto Image SWOT Analysis .................................................................. 69 Table 23: HAWK-2M Product Profile .................................................................................. 71 Table 24: HAWK-2M SWOT Analysis ................................................................................. 71 Table 25: MGU-1000A Product Profile ............................................................................... 72 Table 26: MGU-1000A SWOT Analysis .............................................................................. 73 Table 27: Fuji Computed Radiography Mammography Suite (FCRMS) Product Profile ....... 75 © GlobalData. 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Page 13 GDME1036CFR / Published MAY 2013 Table of Contents Table 28: Fuji Computed Radiography Mammography Suite (FCRMS) SWOT Analysis ..... 76 Table 29: KODAK DirectView CR System Product Profile ................................................... 78 Table 30: KODAK DirectView CR System SWOT Analysis.................................................. 78 Table 31: Xpress CR System Product Profile ...................................................................... 79 Table 32: Xpress CR System SWOT Analysis .................................................................... 80 Table 33: REGIUS PureView Product Profile ...................................................................... 82 Table 34: REGIUS PureView SWOT Analysis..................................................................... 82 Table 35: Agfa CR Mammography Systems (DX-M, CR 30-Xm, and CR 85-X) Product Profile ........................................................................................................................... 84 Table 36: Agfa CR Mammography Systems (DX-M, CR 30-Xm, and CR 85-X) SWOT Analysis .............................................................................................................. 84 Table 37: FFDM SWOT Analysis ........................................................................................ 85 Table 38: Selenia Dimensions Product Profile..................................................................... 87 Table 39: Selenia Dimensions SWOT Analysis ................................................................... 88 Table 40: Selenia Product Profile........................................................................................ 90 Table 41: Selenia SWOT Analysis ...................................................................................... 90 Table 42: Selenia S Product Profile .................................................................................... 92 Table 43: Selenia S SWOT Analysis ................................................................................... 92 Table 44: Selenia Performance Product Profile ................................................................... 94 Table 45: Selenia Performance SWOT Analysis ................................................................. 94 Table 46: Senographe DS Product Profile........................................................................... 96 Table 47: Senographe DS SWOT Analysis ......................................................................... 96 Table 48: Senographe Essential/Senographe Essential E Product Profile ........................... 98 Table 49: Senographe Essential SWOT Analysis ................................................................ 99 Table 50: Senographe Care Product Profile ...................................................................... 101 Table 51: Senographe Care SWOT Analysis .................................................................... 101 Table 52: SenoBright CESM Product Profile ..................................................................... 103 Table 53: SenoBright CESM SWOT Analysis.................................................................... 103 Table 54: MAMMOMAT Inspiration Product Profile ........................................................... 105 © GlobalData. 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Page 14 GDME1036CFR / Published MAY 2013 Table of Contents Table 55: MAMMOMAT Inspiration SWOT Analysis .......................................................... 105 Table 56: Aspire HD/Amulet Product Profile...................................................................... 107 Table 57: Aspire HD/Amulet SWOT Analysis .................................................................... 107 Table 58: MammoDiagnost DR Product Profile ................................................................. 108 Table 59: MammoDiagnost DR SWOT Analysis................................................................ 109 Table 60: MicroDose Product Profile................................................................................. 111 Table 61: MicroDose SWOT Analysis ............................................................................... 111 Table 62: Giotto Image 3D/3DL Product Profile................................................................. 113 Table 63: Giotto Image 3D/3DL SWOT Analysis ............................................................... 113 Table 64: Planmed Nuance/Nuance Excel Product Profile ................................................ 115 Table 65: Planmed Nuance/Nuance Excel SWOT Analysis............................................... 115 Table 66: Fairy DR Product Profile.................................................................................... 117 Table 67: Fairy DR SWOT Analysis .................................................................................. 117 Table 68: Serenity Product Profile..................................................................................... 119 Table 69: Serenity SWOT Analysis ................................................................................... 119 Table 70: Selenia Dimensions 3D System Product Profile................................................. 121 Table 71: Selenia Dimensions SWOT Analysis ................................................................. 121 Table 72: GE Breast Tomosynthesis Product Profile ......................................................... 123 Table 73: GE Breast Tomosynthesis SWOT Analysis ....................................................... 123 Table 74: True 3D Breast Tomosynthesis Product Profile ................................................. 125 Table 75: True 3D Breast Tomosynthesis SWOT Analysis ................................................ 125 Table 76: Giotto Tomo Product Profile .............................................................................. 127 Table 77: Giotto Tomo SWOT Analysis............................................................................. 127 Table 78: FUJIFILM 3Dimensional Mammography Product Profile .................................... 129 Table 79: FUJIFILM 3Dimensional Mammography SWOT Analysis .................................. 129 Table 80: somo.v ABUS Product Profile............................................................................ 131 Table 81: somo.v ABUS SWOT Analysis .......................................................................... 131 Table 82: SonoCine AWBUS Product Profile .................................................................... 133 © GlobalData. 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Page 15 GDME1036CFR / Published MAY 2013 Table of Contents Table 83: SonoCine AWBUS SWOT Analysis ................................................................... 133 Table 84: ACUSON S2000 ABVS Product Profile ............................................................. 135 Table 85: Acuson S2000 ABVS SWOT Analysis ............................................................... 135 Table 86: Terason t3200 Ultrasound System Breast Series Product Profile ....................... 137 Table 87: Terason t3200 Ultrasound System Breast Series SWOT Analysis ..................... 137 Table 88: Aurora 1.5T Dedicated Breast MRI System Product Profile................................ 139 Table 89: Aurora 1.5T Dedicated Breast SWOT Analysis ................................................. 139 Table 90: PEM Flex Solo II Product Profile ....................................................................... 141 Table 91: PEM Flex Solo II SWOT Analysis ...................................................................... 141 Table 92: Computerized Tomography Laser Mammography (CTLM) Model 1020 Product Profile ............................................................................................................... 143 Table 93: Computerized Tomography Laser Mammography (CTLM) Model 1020 SWOT Analysis ............................................................................................................ 143 Table 94: Dilon 6800/Dilon 6800 Acella Product Profile..................................................... 145 Table 95: Dilon 6800/Dilon 6800 Acella SWOT Analysis ................................................... 145 Table 96: LumaGEM Product Profile................................................................................. 147 Table 97: LumaGEM SWOT Analysis ............................................................................... 147 Table 98: Discovery NM 750b Product Profile ................................................................... 149 Table 99: Discovery NM 750b SWOT Analysis ................................................................. 149 Table 100: Breast Cancer Imaging Pipeline Products.......................................................... 162 Table 101: MAMMOMAT Inspiration PRIME Edition SWOT Analysis .................................. 163 Table 102: Philips MicroDose SI SWOT Analysis ................................................................ 164 Table 103: Selenia Dimensions 2D Contrast Imaging SWOT Analysis ................................ 165 Table 104: SenoCase SWOT Analysis................................................................................ 167 Table 105: Electrical Mammogram SWOT Analysis ............................................................ 168 Table 106: Other Key Events in the Breast Cancer Imaging Market .................................... 186 Table 107: GE Healthcare SWOT Analysis, 2013 ............................................................... 190 Table 108: Hologic SWOT Analysis, 2013........................................................................... 192 Table 109: Siemens SWOT Analysis, 2013......................................................................... 193 © GlobalData. 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Page 16 GDME1036CFR / Published MAY 2013 Table of Contents Table 110: Koninklijke Philips Electronics SWOT Analysis, 2013 ........................................ 195 Table 111: Fujifilm Medical Systems, SWOT Analysis, 2013 ............................................... 196 Table 112: Internazionale Medico Scientifica SWOT Analysis, 2013 ................................... 197 Table 113: Planmed, SWOT Analysis, 2013 ....................................................................... 198 Table 114: Konica Minolta Medical Imaging, SWOT Analysis, 2013 .................................... 199 Table 115: Agfa Healthcare, SWOT Analysis, 2013 ............................................................ 200 Table 116: Carestream Health, SWOT Analysis, 2013 ........................................................ 201 Table 117: SonoCine, SWOT Analysis, 2013 ...................................................................... 202 Table 118: Aurora Imaging Technology, SWOT Analysis, 2013........................................... 203 Table 119: Imaging Diagnostic Systems, SWOT Analysis, 2013 ......................................... 205 Table 120: Naviscan, SWOT Analysis, 2013 ....................................................................... 206 Table 121: Dilon Diagnostics, SWOT Analysis, 2013 ......................................................... 207 Table 122: Gamma Medica, SWOT Analysis, 2013............................................................. 208 Table 123: Allengers Medical Systems, SWOT Analysis, 2013 ........................................... 209 Table 124: Sales Forecasts for Breast Cancer Imaging in Brazil, 2009–2018 ...................... 221 Table 125: Physicians Surveyed, By Country...................................................................... 256 © GlobalData. 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Page 17 GDME1036CFR / Published MAY 2013 Table of Contents 1.2 List of Figures Figure 1: Anatomy of the Breast ......................................................................................... 22 Figure 2: Breast Cancer Screening, Diagnostic Evaluation, and Follow-Up......................... 28 Figure 3: Percentage Use of Ultrasound Imaging and MRI for Breast Cancer Screening and Follow-Up, 2009–2016 ........................................................................................ 29 Figure 4: Breast Cancer Risk Factors................................................................................. 31 Figure 5: Projected Breast Cancer Incidence in Brazil, 2012–2018 ..................................... 32 Figure 6: Comparison Between Digital (FFDM) and Analog (FSM) Mammography ............. 37 Figure 7: Use of Alternative Breast Imaging Modalities, 2009–2016 ................................... 44 Figure 8: Performa ............................................................................................................. 51 Figure 9: Alpha RT............................................................................................................. 53 Figure 10: Alpha ST ............................................................................................................. 54 Figure 11: MAMMOMAT 1000 ............................................................................................. 56 Figure 12: MAMMOMAT 3000 Nova .................................................................................... 58 Figure 13: M-IV/M-IV Platinum ............................................................................................. 60 Figure 14: MammoDiagnost ................................................................................................. 62 Figure 15: Planmed Nuance Classic .................................................................................... 64 Figure 16: Planmed Sophie Classic ..................................................................................... 66 Figure 17: Analog Giotto Image ........................................................................................... 68 Figure 18: HAWK-2M........................................................................................................... 70 Figure 19: MGU-1000A ........................................................................................................ 72 Figure 20: Aspire CRm ........................................................................................................ 75 Figure 21: KODAK DirectView CR System ........................................................................... 77 Figure 22: Xpress CR System .............................................................................................. 79 Figure 23: REGIUS PureView Type M ................................................................................. 81 Figure 24: DX-M Digitizer..................................................................................................... 83 Figure 25: Selenia Dimensions ............................................................................................ 86 Figure 26: Selenia ............................................................................................................... 89 Figure 27: Selenia S ............................................................................................................ 91 © GlobalData. 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Page 18 GDME1036CFR / Published MAY 2013 Table of Contents Figure 28: Selenia Performance........................................................................................... 93 Figure 29: Senographe DS .................................................................................................. 95 Figure 30: Senographe Essential ......................................................................................... 97 Figure 31: Senographe Care .............................................................................................. 100 Figure 32: SenoBright CESM*............................................................................................ 102 Figure 33: MAMMOMAT Inspiration ................................................................................... 104 Figure 34: Aspire HD ......................................................................................................... 106 Figure 35: MammoDiagnost DR ......................................................................................... 108 Figure 36: MicroDose ........................................................................................................ 110 Figure 37: Giotto Image 3D/3DL ........................................................................................ 112 Figure 38: Planmed Nuance/Nuance Excel ........................................................................ 114 Figure 39: Fairy DR ........................................................................................................... 116 Figure 40: Serenity ............................................................................................................ 118 Figure 41: Selenia Dimensions 2D System ........................................................................ 120 Figure 42: Senographe Essential ....................................................................................... 122 Figure 43: True 3D Breast Tomosynthesis* ........................................................................ 124 Figure 44: Giotto Tomo ...................................................................................................... 126 Figure 45: Fujifilm 3D Mammography Viewer ..................................................................... 128 Figure 46: somo.v ABUS ................................................................................................... 130 Figure 47: SonoCine AWBUS ............................................................................................ 132 Figure 48: ACUSON S2000 ABVS ..................................................................................... 134 Figure 49: Terason t3200 Ultrasound System Breast Series............................................... 136 Figure 50: Aurora 1.5T Dedicated Breast MRI System ....................................................... 138 Figure 51: PEM Flex Solo II ............................................................................................... 140 Figure 52: CTLM Model 1020 ............................................................................................ 142 Figure 53: Dilon 6800 Acella .............................................................................................. 144 Figure 54: Dilon 6800 ........................................................................................................ 145 Figure 55: LumaGEM ........................................................................................................ 146 © GlobalData. 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Page 19 GDME1036CFR / Published MAY 2013 Table of Contents Figure 56: Discovery NM 750b ........................................................................................... 148 Figure 57: Percentage of False-Positive, False-Negative and Accurate Breast Cancer Diagnoses from 2011–2012 .............................................................................. 155 Figure 58: SenoCase ......................................................................................................... 166 Figure 59: Product Life Cycle ............................................................................................. 170 Figure 60: Detector Evolution............................................................................................. 177 Figure 61: Comparison Between a Typical Direct Conversion Detector and a Direct Optical Switching Detector ............................................................................................ 178 Figure 62: Photon-Counting Detector Technology .............................................................. 180 Figure 63: Linear and High Transmission Cellular Grids ..................................................... 182 Figure 64: Increase in FFDM Systems in the US, 2004–2013 ............................................. 213 Figure 65: Trends in the Use of Mammographic Techniques, 2009–2016 ........................... 214 Figure 66: Sales Forecasts for Breast Cancer Imaging in Brazil, 2009–2018 ...................... 221 © GlobalData. This report is a licensed product and is not to be copied, reproduced, shared or resold in any form. Page 20 GDME1036CFR / Published MAY 2013 Introduction 2 Introduction Breast cancer is the most common form of cancer in women in both the developed and developing world, but is a rare disease in men. The global incidence of breast cancer is increasing due to an increased lifespan and increasing adoption of a westernized lifestyle, which is associated with an increased risk of the disease. Early diagnosis of breast cancer is the foundation for increasing survival rates, and diagnostic imaging is the most widely used technique to achieve early detection, making it a cornerstone of breast cancer control. Diagnostic imaging is used for the early detection of breast cancer in asymptomatic patients in population-based screening programs in most developed countries, or for opportunistic screening in developing nations. Regardless of these differences, imaging has proved to be an indispensable tool in fighting breast cancer and has been proven to reduce mortality. This report provides an analysis of the mammography market in relation to dedicated breast cancer screening and diagnosis in South America (Brazil) and identifies the unmet needs in the market. This report also discusses physician attitudes towards current breast cancer screening and diagnostic techniques, and the future of breast cancer imaging modalities in the face of rapid technological advancements. 2.1 Catalyst The South American breast cancer imaging market is a mature industry with complex dynamics. Therefore, it is essential to examine the market opportunities and barriers that are specific to this region. This report provides an in-depth review of the evolving technologies and the regulatory landscape in the South American breast cancer imaging market. Another key issue, that is discussed, is that purchasing decisions concerning breast cancer screening and diagnostic imaging equipment are complex. Firstly, breast cancer screening and diagnosis involves the challenge of making major purchasing decisions concerning new capital equipment in a technologically fast-evolving market. Secondly, diagnostic imaging modalities are often multipurpose in nature, and so equipment purchasing decisions are not solely driven by the needs of breast cancer screening and diagnosis. For example, a diagnostic mammogram is accompanied by ultrasound imaging in over 50% of cases, but the ultrasound equipment also has various other applications for imaging other parts of the human body. Since the prevalence of breast cancer is higher in women than in men, this report is restricted to the use of imaging techniques for breast cancer screening and diagnosis in women. © GlobalData. This report is a licensed product and is not to be copied, reproduced, shared or resold in any form. Page 21 GDME1036CFR / Published MAY 2013 Appendix 12.9 About MediPoint MediPoint is the flagship product for GlobalData’s Medical team. Each MediPoint report is built from the ground up by our team of healthcare analysts in the US and UK. Each report includes input from experienced physicians and leading Key Opinion Leaders (KOLs). Running throughout each report in the series, “What Physicians Think” quotes provide a unique insight into how healthcare professionals are reacting to events within the industry, and what their responses could mean for industry strategists. 12.10 About GlobalData GlobalData is a leading global provider of business intelligence in the Healthcare industry. GlobalData provides its clients with up-to-date information and analysis on the latest developments in drug research, disease analysis, and clinical R&D. Our integrated business intelligence solutions include a range of interactive online databases, analytical tools, reports, and forecasts. Our analysis is supported by a 24/7 client support and analyst team. GlobalData has offices in New York, Boston, London, India, and Singapore. © GlobalData. This report is a licensed product and is not to be copied, reproduced, shared or resold in any form. Page 260 GDME1036CFR / Published MAY 2013 Appendix 12.12 Disclaimer All Rights Reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form by any means, electronic, mechanical, photocopying, recording, or otherwise without the prior permission of the publisher, GlobalData. © GlobalData. This report is a licensed product and is not to be copied, reproduced, shared or resold in any form. Page 261 GDME1036CFR / Published MAY 2013