Expensive breast cancer screening does not mean better outcomes, study finds

Expensive breast cancer screening does not mean better outcomes, study finds

By Dan Goldberg/The Star-Ledger 
on January 09, 2013 at 8:44 AM, updated January 09, 2013 at 8:45 AM

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Radiologist Dr. Loucia Barton reads a digital mammogram, left, in this 2003 photoRobert Sciarrino/The Star-Ledger 

Medicare spends more than $1 billion a year on breast cancer screenings such as mammography.

 But, according to a new study published by JAMA Internal Medicine, there is no evidence that higher spending benefits older women.

The Yale study looked at breast cancer expenditures — adding in the cost of screening and associated work-up, as well as treatment.

The implications could have significant impact on the medical community, particularly as it relates to seniors.

The United States Preventive Services Task Force has said there is insufficient evidence on the effectiveness of breast cancer screening for women over the age of 75.
Yet Medicare spends more than $400 million a year on screenings for women in this age group, the study found.

"We need further studies to identify which women will benefit from screening, and how to screen effectively and efficiently," said Cary Gross, who is a member of Yale Cancer Center and led the research. "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 mdash; can afford to spend hundreds of millions of dollars on screening programs without evidence to support them."

Researchers calculated Medicare expenditures for breast cancer screening and treatment in 137,274 women who had not had breast cancer before 2006, and followed them for two years to observe screening, breast cancer incidence and associated costs.
The study found significant spending differences across geographic regions — ranging from $40 to $110 — depending mostly on the use of newer, more expensive screening technologies in higher-cost areas.

But there were no greater benefits associated with higher costs.

"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," Gross said. "Specifically, there was no relation between screening expenditures and the detection of advanced cancers."