Medicare Costs for Screening Mammos Have Soared: New Strategies Needed

Medicare spending on mammograms jumped 44% from 2001 to 2009 but did not result in earlier detection of breast cancer. 

Pertinent Points

- From 2001 to 2009, Medicare costs jumped 44% for breast cancer screening. This increase was attributed to the adoption of newer, more expensive screening technologies.

- The costs rose, but there was not a corresponding increase in earlier detection of breast cancer.

- The authors called the pace of this spending increase unsustainable and questioned the clinical reasoning and benefit of the trend.

In identifying the skyrocketing costs, the authors of a recent study published in the Journal of the National Cancer Institute suggested the path is neither financially sustainable nor necessarily in the best interest of the older women undergoing the screening.

"We need to establish screening guidelines for older women that utilize technology appropriately, and minimize unnecessary biopsies and over-diagnosis to keep costs under control," said Brigid Killelea, MD, assistant professor of surgery at Yale School of Medicine and one of the lead authors of the study.

Killelea and coauthors found that newer, more expensive tools, such as digital mammography and computer-aided detection, were among the reasons for the rising costs.

While the use of mammography remained stable between 2001 and 2009-at about 42% of female Medicare patients without a history of breast cancer-they noted a significant increase in digital mammography. Given that digital mammography has not been shown to be superior to standard film mammography in women 65 and older, the authors questioned the rational for employing the more expensive test. (They noted that the cost difference between the two technologies is $42 [$115 for digital mammography vs $73 for film mammography.)

The switch to digital mammography wasn’t the sole reason for the soaring costs. The authors also found considerable increases in the use of other treatment tools and subsequent procedures, such as breast MRI and biopsy. All said, Medicare spending for breast screening and related procedures increased during the eight-year period, from $666 million to $962 million.

Even among women 75 years and older, for whom the U.S. Preventive Services Task Force does not recommend mammography, the authors found that Medicare costs for the screening rose.