Breast cancer screening costs high, despite lack of improved outcomes

Annual Medicare spending on breast cancer is high--more than $1 billion a year--with no evidence that higher spending actually results in greater benefits for older patients, according to a study published online Jan. 7 in JAMA Internal Medicine.

Researchers, led by Cary Gross, M.D., an associate professor of internal medicine at Yale School of Medicine, calculated the expenditures on screening and treatment for over 137,000 women who had never had breast cancer before 2006. They found that the annual cost to fee-for-service Medicare was $1.08 billion for breast cancer screening-related procedures (screening and workup) and $1.36 billion for treatment.

The researchers also calculated that more than $410 million was spent annually on screening Medicare beneficiaries over the age of 75. The U.S. Preventive Services Task Force has said there is not enough evidence to say whether or not women in this age group should be screened.

In addition, the researchers found that rates of Medicare spending for breast cancer screening varied across geographic regions--ranging from $40 to $110 per Medicare patient. They suggested that these higher costs are being driven by the use of newer, more expensive technologies, such as digital mammography and computer-aided detection.

"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," Gross said, according to an announcement. "Specifically, there was no relation between screening expenditures and the detection of advanced cancers."

In addition, Gross told Time magazine: "We are not saying that digital mammography is not good or it is good. All we are saying is that it is more expensive. We are employing these new and more expensive techniques and we are not really sure it's helping women."

Gross also told the Hartford Courant that he hopes "these findings will push the field not only to consider whether [screening] is effective, but also to consider some of the costs of it."

For more:
- see the study abstract
- see the announcement
- read the article in Time magazine
- read the article in the Hartford Courant