Costlier breast screening for seniors not tied to better outcomes: study

Regions that spent the most to screen women older than 65 years old for breast cancer were more likely to use new and more expensive screening technologies, but did not report better outcomes, according to the findings of a new study.

The study, published online today by JAMA Internal Medicine, analyzed how much Medicare spends each year on breast cancer screening for women 65 or older. It also compared the outcomes for women who lived in regions that spent more or less on screening for breast cancer.

Medicare annually spends $1.36 billion on breast cancer treatment for women 65 or older, in addition to $1.08 billion in breast cancer screenings and workups each year. For women 75 or older, screening-related costs total $410 million each year.

“The cost of screening almost equaled the cost of treatment,” said Dr. Cary Gross, co-author and associate professor of medicine at the Yale University School of Medicine.

The researchers found that higher screening costs in certain regions are often driven by the use of new technologies, such as computer-aided detection, which was approved by the Food and Drug Administration in 1998, and digital mammography, which was introduced two years later.

“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,” the researchers wrote.

Some regions spent twice as much on screening, but did not show lower incidences of metastatic cancer or higher treatment costs, according to Gross. However, the study did find that women who lived in the high screening-cost regions were more likely to be diagnosed with early-stage cancer, although the findings may suggest over-diagnosis.

“The bulk of regional variation in spending was related to these new and more expensive technologies,” Gross said.

While other research has found that digital mammography and CAD can better screen certain populations of women, such as premenopausal or perimenopausal women who are younger than 50 and have dense breast tissue, this study found that the new technologies are less effective in screening older women, when compared to using film mammography.

Since the introduction of digital mammography to the market more a decade ago, about 70% of certified mammography facilities in the U.S. had at least one digital unit in 2010, according to the FDA. Gross noted that digital mammography may now be the only option for patients who live in certain regions.

A commentary also published today by JAMA Internal Medicine raised questions about whether new technology has improved outcomes for older women. Three years ago, the U.S. Preventive Services Task Force issued controversial guidelines that included a recommendation that routine screening end when women are 74 years old.

“Although the evidence from this study is compelling, it does not fully address the question of whether investment in more expensive digital technology improves breast cancer outcomes for older women,” the authors wrote in the online commentary.