Increase in the cost of breast cancer screening results in no benefit for older women

Killelea et al in their paper published by the JNat Cancer Inst report that cost for breast cancer screening have increased dramatically since the introduction of newer imaging technologies such as digital mammography, computer aided detection, MRI and image guided biopsies, but the outcomes remain undefined, particularly among older women.

The authors used the Surveillance, Epidemiology, and End Results-Medicare linked database, and constructed two cohorts of women without a history of breast cancer, which they followed for 2 years. They compared the use and cost of screening mammography including digital mammography, CAD, and adjunct procedures such as CAD, breast ultrasound, MRI, and biopsies between the period of 2001 and 2002 and the period of 2008 and 2009.

There were 137150 women (mean age = 76.0 years) in the early cohort (2001-2002) and 133097 women (mean age = 77.3 years) in the later cohort (2008-2009). The use of digital image acquisition for screening mammography increased from 2.0% in 2001 and 2002 to 29.8% in 2008 and 2009 (P < .001). CAD use increased from 3.2% to 33.1% (P < .001). Average screening-related cost per capita increased from $76 to $112 (P < .001), with annual national fee-for-service Medicare spending increasing from $666 million to $962 million. There was no statistically significant change in detection rates of early-stage tumors (2.45 vs 2.57 per 1000 person-years; P = .41).

The authors concluded that although breast cancer screening-related costs increased substantially from 2001 through 2009 among Medicare beneficiaries, a clinically significant change in stage at diagnosis was not observed.