The Cost of Breast Cancer Screening in the Medicare Population by Cary P Gross et al, examines whether investments in new and more expensive breast cancer screening technologies, such as digital mammography, provide a good return on investment – with regard to the older US female population – but also throws up more evidence of overdiagnosis and lack of screening effectiveness. Their research showed that women residing in areas of high cost screening in the United States were far more likely (78%) to be diagnosed as having early stage or in situ breast cancer as those in lower-cost areas – but not more likely to have advanced disease.
The findings are consistent with those of the Norwegian Screening Trial which found that women living in an area with a mammography screening program were significantly more likely to be diagnosed with breast cancer than those without screening and that 15% to 25% of cases were overdiagnosed. (Kalager M, Adami H-O, Bretthauer M, Tamimi RM. Overdiagnosis of invasive breast cancer due to mammography screening: results from the Norwegian screening
program. Ann Intern Med. 2012;156(7):491-499)
In his commentary, ‘Costs, evidence and value in the Medicare Program. The challenges of technology innovation in breast cancer prevention and control’, Dr Mandelblatt comments, ‘Notably, among women 65 or older, whose breasts have a higher proportion of fat than dense mammary tissue, there was actually a strong trend for digital mammography to perform worse than plain film mammography’ (Pisano ED, Hendrick RE, Yaffe MJ, et al; DMIST Investigators Group. Diagnostic accuracy of digital versus film mammography: exploratory analysis of selected population subgroups in DMIST. Radiology. 2008;246(2):376-383.)
Jama Intern Med 2013;173 (3): 220-226 11 February 2013 published online 7 January 2013.
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