Following USPSTF Mammography Screening Guidelines Could Save Billions of Dollars and Result in More Women Screened
Although controversial, reducing mammography screening frequency from annually to biennially for women aged 50 to 74 could save the health-care system billions of dollars annually and screen 15% more women compared with the current practice, according to a cost analysis by O’Donoghue et al. The findings are published in Annals of Internal Medicine.
In 2009, the U.S. Preventive Services Task Force (USPSTF) set off a firestorm of controversy when it recommended biennial mammography screening for women between the ages of 50 and 74 years, with consideration of screening women aged 40 to 49 years on a risk-benefit basis. The recommendations put the USPSTF at odds with screening guidelines from professional organizations, such as the American Cancer Society, which call for annual screening from age 40 years and continued regardless of a woman’s age unless she has serious, chronic health problems.
The controversy continues today even though the USPSTF recommendations of less frequent screenings are based on a rigorous review of screening trials and work from the Cancer Intervention and Surveillance Modeling Network. Because the cost tradeoffs of different screening recommendations are unknown, O’Donoghue et al developed a computer simulation model to estimate the population-level cost of three screening strategies.
Study Method and Results
The computer model estimated the cost of mammography screening in the United States in 2010. The three screening strategies included annual screening (for women aged 40 to 84 years), biennial screening (for women aged 50 to 69 years), and screening according to USPSTF guidelines (biennial for those aged 50 to 74 years and personalized based on risk for those younger than 50 years and based on comorbid conditions for those 75 years and older).
The analysis showed that the estimated cost of mammography screening in 2010 was $7.8 billion, with approximately 70% of women screened. The simulated cost of screening 85% of women was $10.1 billion ($2.3 billion more than current practice), $2.6 billion, and $3.5 billion for annual, biennial, and USPSTF guidelines, respectively.
The researchers found that the largest drivers of cost were screening frequency, percentage of women screened, cost of mammography, percentage of women screened with digital mammography, and percentage of mammography recalls.
“Our study shows that mammography screening in the United States, as currently implemented, is estimated to cost approximately $7.8 billion per year. A USPSTF strategy that screened 85% of U.S. women would save $4.4 billion dollars and screen 15% more women compared with current practice. If an annual strategy were implemented to screen 85% of the population, it would cost an estimated $10.1 billion per year, or $2.3 billion more than current practice. Finally, screening biennials and eliminating screening for women in their 40s or those who are older than 70 years would cost $2.6 billion, which is not much less than the broader USPSTF strategy,” wrote the study authors.
Following mammography screening guidelines, such as those from the USPSTF, would “likely improve the quality of screening and is in line with our national goals of advancing health-care delivery while improving cost-efficiency,” concluded the researchers.
Laura Esserman, MD, MBA, of the University of California, San Francisco, is the corresponding author for the Annals of Internal Medicine article.
Primary funding for this study was provided by the University of California and the Safeway Foundation. The researchers reported no conflicts of interest.
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