Breast Cancer Screening in Older Women Proving Costly, Likely Ineffective

According to a recent study conducted by researchers at the Yale University School of Medicine, a hefty portion of the $1 billion-plus Medicare pays out each year for breast cancer screening may be ill-spent.

Published online Jan. 7 in JAMA Internal Medicine, the study looked at 2006-2007 Medicare expenditures data for breast cancer screening-related procedures (i.e., screening plus associated workup) and treatment in 137,274 female beneficiaries ages 66-100 who had no history of breast cancer to observe screening patterns, breast cancer incidence and associated costs during this two-year period.

The study found that $410.6 million of screening-related money was spent annually on women 75 or older, regardless of the fact that guidelines from both the AAFP and the U.S Preventive Services Task Force have concluded that insufficient evidence exists to assess the benefits and harms of screening mammography in this age group.

Moreover, the researchers said, regional variation in screening-associated costs is substantial, and often is driven by the use of newer and more expensive technologies.

The study does point out that women residing in the "high screening-cost regions" were as much as 78 percent more likely than women in lower-cost regions to be diagnosed as having early-stage or in situ breast cancer.

Still, "It is unclear whether higher screening expenditures are achieving better breast cancer outcomes," the researchers concluded.

"The difference in crude incidence of overall and early-stage cancers between high- and low-cost areas was approximately 1 per 1,000 women, which was statistically significant," the researchers said. "Notably, the difference in the incidence of diagnosed stage IV cancer was not significant, and the absolute difference between highest- and lowest-cost areas was approximately 1 in 100,000 women. Taken together, these findings suggest overdiagnosis of breast cancer in the higher-cost regions."

According to the researchers, this focus on costs associated with screening is especially important because newer and often more costly screening technologies, such as digital mammography and computer-aided detection, have expanded clinicians' options and are diffusing into the marketplace.

"The adoption of these new technologies can increase costs directly through reimbursement for the tests and also lead to higher rates of supplementary imaging, biopsy, or cancer detection," the researchers said. "It is critical to assess the relation between screening expenditures and population outcomes, since newer modalities can increase cancer detection rates but may not improve patient outcomes, particularly among older women."