More money spent on breast Ca screening may not lead to better outcomes

Medicare spending on breast cancer screening exceeds $1 billion annually in the fee-for-service program, according to a recent study. Despite this, the researchers who conducted the study concluded that it is unclear whether higher screening expenditures are achieving better breast cancer outcomes.

The goal of the study, which appeared in the January 2013 issue of JAMA Internal Medicine, was to determine whether regional-level screening expenditures are associated with cancer stage at diagnosis or treatment costs, particularly because newer breast cancer screening technologies, like digital mammography and computer-aided detection (CAD), are now commonly used in the care of older women.

The researchers used the linked Surveillance, Epidemiology, and End Results–Medicare database to identify 137,274 women aged 66 to 100 years who had not had breast cancer and assessed the costs to fee-for-service Medicare of breast cancer screening and

workup during 2006 to 2007. For women who developed cancer, the researchers calculated initial treatment costs. They then assessed screening-related costs at the hospital referral region (HRR) level and evaluated the association between regional expenditures and workup test utilization, cancer incidence, and treatment costs.

The researchers found that in the United States, the annual costs to fee-for-service Medicare for breast cancer screening-related procedures (comprising screening plus workup) and treatment expenditures were $1.08 billion and $1.36 billion, respectively. For women 75 years or older, annual screening-related expenditures exceeded $410 million.

In a commentary that accompanied the article, Jeanne S. Mandelblatt, MD, MPH; Anna N.A. Tosteson, ScD; and Nicolien T van Ravesteyn, MSc, cautioned that the study “focused on the period early in the adoption of digital screening (2006-2007), when costs related to false-positive readings may be highest because of the learning curve in reading the images.”