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Study Skeptical Of High-Cost Breast Screening

January 8, 2013
Written by: , Filed in: Breast Imaging
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A new Yale study casts doubt on the cost effectiveness of newer and more expensive breast cancer screening techniques, such as digital mammography and computer-aided detection, for older women.

The study—published online Monday in JAMA Internal Medicine (formerly Archives of Internal Medicine)—also seems to offer little evidence to support screening of women 75 or older at all. The most recent recommendations from the U.S. Preventive Services Task Force say there is insufficient evidence to make a recommendation either way regarding screening mammography for women in that age group.

The Yale Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center calculated how much Medicare paid for breast cancer screening and treatment for 137,274 female beneficiaries who had not had breast cancer before 2006. It followed them for two years, 2006–2007, and tracked screening, incidence of breast cancer, and costs of screening and treatment.

Screening costs varied widely by region—from $42 to $107 per patient. Use of digital mammography and CAD accounted for 65 percent of the difference. Women in areas with high screening costs were more likely to be diagnosed with early-stage cancer, but there was no significant difference in diagnosis of late-stage cancer. “Taken together, these findings suggest overdiagnosis of breast cancer in the higher-cost regions,” the study says.

Lead author Cary P. Gross, MD, said in a Yale news release:

Although screening costs varied more than two-fold across geographic regions, there was no evidence that higher expenditures were benefiting women living in the high-cost regions. Specifically, there was no relation between screening expenditures and the detection of advanced cancers.

Dr. Gross is associate professor of internal medicine at Yale School of Medicine and director of COPPER.

The researchers estimated that Medicare pays more than $400 million a year to screen women 75 or older. “We need further studies to identify which women will benefit from screening and how to screen effectively and efficiently,” said Dr. Gross. “In some instances, breast cancer screening can save lives. But no woman wants to undergo testing if it is likely to cause more harm than good, and no health system—particularly ours—can afford to spend hundreds of millions of dollars on screening programs without evidence to support them.”

Related seminar: UCSF Breast Imaging and Digital Mammography (free domestic shipping)

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