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 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 Tuesday in JAMA Internal Medicine. The study found no relation between expenditures and detection of advanced cancers.
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.
“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 in New Haven, Conn., said.
Researchers determined Medicare costs in 2006 and 2007, the latest years for which data were available, for mammograms and treatment in 137,274 women ages 66 to 100 who didn't have the disease. They found that the average cost for screening per beneficiary was $63. In some regions, the cost of screening was as high as $110. 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 advisory group to the government, in 2009 recommended against routine mammograms for women ages 40 to 49 who aren't at 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 benefits older women because the newer equipment is designed to provide a better look at dense breasts found more commonly in women before menopause.
