Effect of Computer-Aided Detection in Mammography Screening on Cost and DCIS Diagnosis in Medicare Population
In a study reported in a research letter in JAMA Surgery, Fenton et al found that a sizable proportion of ductal carcinoma in situ (DCIS) diagnoses are attributable to computer-aided detection in mammography screening in the Medicare population and that use of computer-aided detection in this setting is associated with a substantial addition to the cost of screening.
As noted by the investigators, evidence suggests that computer-aided detection use increases the rate of false-positive findings and detection of DCIS in screening mammography; increased DCIS detection could result in overdiagnosis of breast cancer among older women at higher risk of competing causes of death.
Procedures Attributable to Computer-Aided Detection
Between January 2001 and December 2009, the prevalence of computer-aided detection in Medicare screening mammograms increased from 3.5% to 79.7%. In 2009, 18.2% of diagnostic mammograms, 5.3% of breast ultrasonograms, 7.4% of breast biopsies, and 11.9% of DCIS diagnoses were attributable to computer-aided detection. Over the study period, 4,612 additional Medicare patients were treated for DCIS as a result of computer-aided detection. If computer-aided detection were to be used in all Medicare screening mammograms, 14.5% of all DCIS diagnoses would be attributable to computer-aided detection, and 1,118 additional Medicare patients would undergo DCIS treatment each year.
Costs
Over the study period, Medicare total costs associated with computer-aided detection use were $278,564,950, including $163,443,470 for supplemental fees, $53,812,033 for downstream diagnostic and interventional procedures, and $61,690,112 for DCIS treatments. If computer-aided detection were used in all screening mammograms, annual computer-aided detection–associated Medicare costs would be > $67 million, representing an increase of approximately 7% in the approximately $1 billion annual Medicare cost for mammography screening.
As stated by the investigators: “The long-term implications of increased DCIS detection in the Medicare population are uncertain. On one hand, the intent of screening is to detect breast cancers earlier, when treatments can be curative and less morbid. However, many DCIS lesions may be overdiagnosed, particularly in an older population… Because of broad dissemination in the United States, [computer-aided detection] likely accounts for a substantial fraction of diagnostic breast imaging, breast biopsies, and DCIS diagnoses among the Medicare population, with high resultant costs.”
Joshua J. Fenton, MD, MPH, of the University of California, Davis, is the corresponding author for the JAMA Internal Medicine article.
The study was supported by the National Institutes of Health, Center for Healthcare Policy and Research, University of California, Davis, and National Cancer Institute. The study authors reported no potential conflicts of interest.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
