|Articles|April 8, 2015

US bill for false-positive mammograms: $4 billion annually

A recent report sheds light on how much false-positives and overdiagnosis of breast cancer cost. Additionally, new research examines the impact of the number of live births on future heart health in the mother and provides further evidence of the efficacy of cfDNA testing.

An analysis of routine mammography in women aged 40 to 59 shows that false-positive results and overdiagnosis of breast cancer are costing the United States $4 billion every year. Published in Health Affairs, the report on a nationally representative sample suggests greater expenditures-and more economic impact-for false-positives than had been previously thought.

Using medical claims data from a major US healthcare insurance plan for 702,514 women spanning 2011 to 2013, researchers from Boston Children’s Hospital and Harvard University assessed mammography outcomes in women aged 40 to 49 and 50 to 59 who underwent routine screening.

The authors calculated a false-positive rate of 11%--or 3.2 million women receiving such results. That, taken together with overdiagnosis of invasive breast cancer and ductal cancer in situ (DCIS) at rates of 22% and 86%, respectively, brought the price tag for women aged 40 to 59 to $4 billion annually.

The average cost of each false-positive mammogram, invasive breast cancer, and DCIS was $852, $51,837, and $12,369, respectively. In women aged 40 to 49, an average of $867 was spent related to false-positive mammograms, compared with $833 for women aged 50 to 59. The difference was largely ascribed to more use of imaging in younger women.

False-positive mammograms were more likely in the younger women (odds ratio 1.25; 95% confidence interval [CI]: 1.23-1.26; P<0.001). However, a diagnosis of invasive breast cancer was less likely in that group: OR 0.77; 95% CI: 0.72-0.84; P<0.001)

Looking at breast cancer treatment, the researchers found that younger women with invasive breast cancer were more likely to undergo total mastectomy (41% vs 30.4%), at a cost $1,459 versus $1,012 for a partial mastectomy. Reconstruction, too, was more common in the younger group (35.6% vs 25.4%; $3747 vs $2364).

Commenting on limitations of their study, the authors noted that: (1) all diagnoses and procedures performed may not have been captured in the claims data; (2) some DCIS cases may be have been misclassified as invasive breast cancer, given that the rate of DCIS was lower than expected; and (3) the costs may not be generalizable to other populations because the data were from a single commercial health plan.

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