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Despite a nearly $300 million increase in Medicare spending linked to a sharp rise in the use of newer, more-sensitive breast-cancer screening technologies, no changes were seen in early detection rates, a study finds

Digital mammography costlier, shows no detection-rate advantages: study


By Sabriya Rice
Posted: July 16, 2014 - 3:15 pm ET
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Despite a nearly $300 million increase in Medicare spending linked to a sharp rise in the use of newer, more-sensitive breast-cancer screening technologies, no changes were seen in early detection rates, a study in the Journal of the National Cancer Institute found. Healthcare dollars may be wasted, some experts say, when widespread adoption of a new test precedes evidence of its meaningful clinical benefit.

Annual Medicare spending for screening mammography increased from $666 million for the period 2001-2002 to $962 million for the period 2008-2009, according to the JNCI study from researchers at Yale University School of Medicine.

Researchers followed two cohorts of women for two-year periods, including 137,150 women between 2001 and 2002, and 133,097 women between 2008 and 2009.

The number of women screened using digital imaging jumped from 2% in the 2001-2002 timeframe to 29.8% in the 2008-2009 timeframe, and the use of computer-aided detection rose from 3.2% to 33.1% over those two time periods. However, use of these technologies did not lead to changes in cancer detection rates, the researchers found.

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In light of rapid increases in technology-usage, the study authors said more research is needed to compare the costs and benefits of screening mammography in older women. The analysis used data from the Surveillance, Epidemiology, and End Results (SEER) Medicare database to evaluate usage and costs associated with screening women ages 66 and older.

When a new technology is widely adopted before evidence of its meaningful clinical benefit has been proven, healthcare dollars may be wasted, noted an editorial on the study. The transition to digital breast-cancer screening in the U.S. has led to only small or no health gains, and may possibly be less cost-efficient than previous methods, said Dr. Karla Kerlikowske of the San Francisco Veterans Affairs Medical Center, Rebecca Hubbard of the Group Health Research Institute and Anna Tosteson of the Dartmouth Institute for Health Policy and Clinical Practice.

“Our enthusiasm for new technologies should not replace strong, consistent evidence that the benefits of the new technology outweigh the harms in a clinically important way,” they wrote.

The most effective strategy for deploying breast-cancer screening technologies continues to generate disagreement, and breast cancer researchers say consensus is needed, not only on when to screen, but how often and with what tools.

A study from June, which compared performance outcomes from 13 academic and nonacademic breast centers, found fewer patients were called back for additional imaging, and there was a higher rate of breast-cancer detection when screening extended beyond digital mammography to include a new 3-D breast-imaging technique called tomosynthesis. Though many expressed enthusiasm for the results, several limitations were noted, including the lack of a randomized trial design which might uncover other reasons for the findings. Follow-up data also were not available to allow evaluation of false-negative results.

In the editorial for the JNCI study, the authors noted the rapid diffusion of tomosynthesis and suggested that, without further data, its use could potentially result in “déjà vu all over again.”

Follow Sabriya Rice on Twitter: @MHSRice


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