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Costly Breast Cancer Screenings Don’t Guarantee Better Outcomes for Older Women

Researchers find no relation between screening costs and detection of advanced cancers (Jan. 7)

Even though Medicare spends more than $1 billion each year on breast cancer screenings, such as mammography, there is no evidence that higher spending benefits older women, researchers at the Yale School of Medicine found in a study published online in JAMA Internal Medicine.

The new study sought to provide a comprehensive understanding of breast cancer expenditures that incorporate the cost of screening and associated work-up, as well as treatment. The researchers assessed overall national costs as well as variations in costs across geographic regions. They calculated Medicare expenditures for breast cancer screening and treatment in 137,274 female Medicare beneficiaries who had not had breast cancer before 2006, and followed them for 2 years to observe screening, breast cancer incidence, and associated cost.

The researchers found substantial variation across geographic regions in Medicare spending for breast cancer screening — ranging from $40 to $110 per female Medicare beneficiary. Most of the difference in costs was due to the use of newer, more expensive screening technologies in the higher-cost areas.

“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,” said study leader Dr. Cary Gross. “Specifically, there was no relation between screening expenditures and the detection of advanced cancers.”

Recent guidelines from the U.S. Preventive Services Task Force have concluded that there is insufficient evidence regarding the effectiveness of breast cancer screening for women aged 75 years and older. The new study found that more than $400 million is being spent annually on screening Medicare beneficiaries in this age group.

“We need further studies to identify which women will benefit from screening, and how to screen effectively and efficiently,” said 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.”

Source: Yale University; January 7, 2013.

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