New technologies, such as digital mammography and computer-aided detection, are being used for breast cancer screening of Medicare patients. They’re costing more, but they’re not finding cancers earlier.
That’s the conclusion of a new study led by Yale School of Medicine researchers, using data from the National Cancer Institute‘s Surveillance, Epidemiology and End Results (SEER) Program. The researchers determined that mammography costs for Medicare patients shot up between 2001 and 2009—from $666 million in 2001–2002 to $962 million in 2008–2009 for approximately the same number of mammograms—but that there were no significant changes in detection rate, nor in the stage or size of tumors at the time of detection.
I view this as important preliminary data suggesting there has been no improvement whatsoever. As far as why there was no improvement, it’s either because the new technology was not more effective or maybe we just need longer follow-up time, and only time will tell.
Dr. Gross is professor of internal medicine at Yale School of Medicine and director of the Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center at Yale Cancer Center. An article about the study was to have been published online July 1 in the Journal of the National Cancer Institute but as of this writing doesn’t seem to have shown up yet.
“Screening mammography is an important tool, but this rate of increase in cost is not sustainable,” said Brigid K. Killelea, MD, co-lead author of the study. “We need to establish screening guidelines for older women that utilize technology appropriately and minimize unnecessary biopsies and overdiagnosis to keep costs under control.”
So what should we be doing? Should we keep film mammography machines around just for Medicare patients—even though that would create compatibility issues regarding electronic health records? “At this point, I don’t think anyone would look at this study and say they should dig the old film machines out of the closet,” Dr. Gross told NPR. Instead, he said, the efficacy, cost, and insurance coverage of future technologies should be discussed before those technologies are deployed.
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Related CME seminar (up to 7.5 AMA PRA Category 1 credits™): Mammography – A State of the Art Review