Increases Seen in Use of Digital Mammography and Related Screening Costs in Medicare Population, but No Increase in Early Detection
In a study of use of breast cancer screening modalities in the Medicare population reported in the Journal of the National Cancer Institute, Killelea et al found significant increases in use of digital image acquisition and computer-aided detection and cost of screening, but no increase in rate of detection of early-stage tumors between 2001–2002 and 2008–2009.
In the study, the SEER (Surveillance, Epidemiology, and End Results)–Medicare linked database was used to identify two cohorts of women (2001–2002 and 2008–2009) without a history of breast cancer, with each cohort being followed for 2 years.
No Increase in Early Detection
Among 137,150 women (mean age = 76.0 years) in the early cohort vs 133,097 women (mean age = 77.3 years) in the later cohort, the use of digital image acquisition in screening mammography increased from 2.0% to 29.8% (P < .001) and the use of computer-aided detection increased from 3.2% to 33.1% (P < .001). The average screening-related cost increased from $76 to $112 per person (P < .001), representing an increase in annual national fee-for-service Medicare spending from $666 million to $962 million. The rate of detection of early-stage tumors was 2.45/1,000 person-years in the early cohort vs 2.57/1,000 person-years in the later cohort (P = .41).
The investigators concluded, “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.”
Cary P. Gross, MD, of Yale University School of Medicine, is the corresponding author for the Journal of the National Cancer Institute article.
The study was supported by the National Cancer Institute and Yale Comprehensive Cancer Center. The study authors reported no potential conflicts of interest.
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