Age, cost & breast cancer screening

As the U.S. tries to tame burgeoning Medicare costs, researchers are attempting to determine the costs and benefits of healthcare services delivered to older Americans. One current flash point is screening mammography.

By focusing on optimal screening practices and intervals, researchers have accrued more data that suggest a two-year screening interval may be cost-effective and also preserve the benefits of screening.

Breast cancer screening among Medicare beneficiaries topped $1 billion in 2006-2007, reported researchers online Jan. 7 in JAMA Internal Medicine. They also found screening-related costs of $410.6 million among women older than 75 years and a disparity in costs and utilization of work-up procedures based on Hospital Referral Region.

The researchers cautioned that the cost curve may grow steeper as Medicare covers newer screening modalities that can increase costs via higher reimbursement and also lead to higher rates of supplementary imaging, biopsy or cancer detection.

Meanwhile, women aged 65 and older derive similar benefits from biennial screening mammography and annual exams, researchers reported online Feb. 5 in the Journal of the National Cancer Institute. The authors found no differences in comorbidity, screening interval and tumor stage at diagnosis during the course of the study.

The authors estimated that there are 4.9 million women aged 66 to 89 years in the U.S. with comorbidities and 14.3 million without comorbidities. If they all underwent annual instead of biennial mammography, that would translate to approximately one million additional false-positive exams and 290,000 additional biopsy recommendations among women with comorbidities, and 2.86 million false-positives and 860,000 additional biopsies among women without comorbidities.

In 2009, when the U.S. Preventive Task Services revised its screening mammography recommendations, it passed the buck on screening among women ages 75 and older, and cited insufficient evidence about the harms and benefits of breast cancer screening in this age group. Professional societies are equally mum on the subject of screening in the rapidly expanding cohort.

Is it time for breast imagers to clarify recommendations, or is a case-by-case approach warranted? How does your practice address these challenges? Email and let us know.

Lisa Fratt, editor