January 23, 2019
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Higher breast-cancer screening costs don’t mean better detection

NEW YORK — More advanced and costlier breast cancer screenings don’t always result in better detection of the disease in women ages 66 and older, a Yale University study found.

Medicare, the U.S. health insurance program for the elderly and disabled, spends about $1.08 billion a year on breast screenings and follow-up tests, almost as much as the $1.36 billion spent to treat the disease, according to research published Monday in JAMA Internal Medicine. The study found no relation between expenditures and detection of advanced cancers.

The study, the first to compile national estimates for screening expenditures, showed tests were twice as expensive in certain regions than in others. Results suggest more research is needed to identify which patients need screening and how to test more effectively, said Cary Gross, a lead study author.

“The fact that we are facing such severe budget constraints as a nation and the fact that Medicare is such a major expense in the federal budget, our findings really reinforce the imperative to clarify how we’re spending our scarce Medicare dollars on cancer screening and to make sure we’re using them effectively,” Gross, an associate professor of medicine at Yale University in New Haven, Conn., said in a telephone interview. “This certainly does not close the door on mammography in older women. My hope is these data will be used to reinforce the need for further research on how we screen for breast cancer.”

Researchers determined Medicare costs in 2006 and 2007, the latest years data were available, for mammograms and treatment in 137,274 women ages 66 to 100 who didn’t have the disease. They also looked at expenditures by region of the United States.

They found that the average cost for screening per beneficiary was $63, while the mean cost of initial treatment was $16,600. In some regions, the cost of screening was as high as $110 per female Medicare recipient and most of the higher cost was because of newer, more expensive screening technologies, the study said.

For those areas where screening expenses were highest, there was no increased detection of advanced cancers or a corresponding reduction in treatment costs, Gross said. Women in the higher-spending areas were more often diagnosed with early breast cancer, which Gross said could lead to unnecessary treatment as not all of those cancers would harm an older woman in her lifetime.

The U.S. Preventive Services Task Force, an independent medical advisory group to the government, in 2009 recommended against routine mammograms for women ages 40 to 49 who aren’t at an increased risk for breast cancer, while suggesting a mammogram once every two years for those 50 to 74. The American Cancer Society suggests annual mammograms starting at 40.

Jeanne Mandelblatt, who wrote an accompanying editorial, said there’s no evidence suggesting that the newest technology with its higher costs benefits older women. That’s because the newer equipment is designed to provide a better look at dense breasts found more commonly in women before menopause. More studies are needed to look at whether this technology is useful for older women and a good buy for Medicare, she said.

“We need to advocate for more research in the older population so that women and men can have answers when they ask, ‘Is this going to harm me? Is this going to help me?'” Mandelblatt, associate director for Population Sciences at the Lombardi Comprehensive Cancer Center and a professor of oncology at Georgetown University in Washington, said in a Jan. 4 telephone interview.

Policymakers “need to examine evidence and attempt to apply the evidence in a more personalized manner in the Medicare program,” she said.

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