Medicare Costs for Breast Cancer
Screenings Skyrocket, But Do Patients Benefit?
While U.S. Preventive Services does
not recommend breast cancer screening for senior women 75 and older,
Medicare still spent an increasing amount on this age group
By Karen N. Peart, Yale University
3, 2014 - Breast cancer screening costs for Medicare patients
skyrocketed between 2001 and 2009, while the number of screening
mammograms performed remained stable. What makes this even worse is that
the increased cost did not lead to earlier detection of new breast
cancer cases, says a new study by Yale School of Medicine researchers.
The study published in the July 1
Journal of the National Cancer Institute focused on the adoption
of newer imaging technologies in the Medicare population, such as
Dr. Brigid Killelea, assistant
professor of surgery, and Dr. Cary Gross, 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, were lead authors of the study.
Screening mammography is an
important tool, but this rate of increase in cost is not sustainable,
said Killelea, assistant professor of surgery. We need to establish
screening guidelines for older women that utilize technology
appropriately, and minimize unnecessary biopsies and over-diagnosis to
keep costs under control.
Gross, Killelea, and other members
of the Yale COPPER research team explored trends in the cost of breast
cancer screening. They identified the use of newer, more expensive
approaches including digital mammography and computer aided detection
(CAD), as well as the use of other treatment tools and subsequent
procedures such as breast MRI and biopsy, between 2001-2002 and
2008-2009. They also assessed the change in breast cancer stage and
incidence rates between the two time periods.
They found that use of screening
mammography was similar between the time periods at around 42% of
female Medicare beneficiaries without a history of breast cancer. There
was a large increase in the use of digital mammography technology, which
is more expensive than standard film technology ($115 vs. $73 per
mammogram) and has not been shown in clinical trials to be superior for
women 65 years or older.
The team also found a considerable
increase in the use of other newer, more expensive screening and
related-adjunct technologies. As a result, Medicare spending for breast
screening and related procedures increased from $666 million (in
2001-2002) to $962 million (2008-2009).
While the United States Preventive
Services Task Force does not recommend breast cancer screening for women
age 75 years and older, the COPPER team found that Medicare still spent
an increasing amount per woman 75 years and older in the study.
We need further studies to
identify which women will benefit from screening, and how to screen
effectively and efficiently, said Gross.
But we cannot simply adopt new
technologies because they theoretically are superior the health system
cannot sustain it, and more importantly our patients deserve a sustained
effort to determine which approaches to screening are effective and
which ones are not. 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.
Other authors on the study include
Jessica Long, Anees Chagpar, Xiaomei Ma, Rong Wang, and Joseph Ross.
This study was supported by the
National Cancer Institute and the P30 Cancer Center Support Grant (CCSG)
at the Yale Cancer Center.
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