Did you know that Medicare spends over $1 billion per year on breast cancer screenings - yet there is no convincing evidence that higher spending actually benefits the health prospects of older women?
This astonishing finding was part of a study carried out by department of Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center at Yale School of Medicine and published recently in JAMA Internal Medicine.
The COPPER team examined breast cancer expenditures that include cost of screening, associated workup and treatment based on overall national costs, and also considered variation in costs across geographic regions.
Specifically, they calculated Medicare expenditures for breast cancer screening and treatment in 137,274 female Medicare beneficiaries who did not have breast cancer before 2006, and followed them for two years to observe and record screening, breast cancer incidence, and associated costs.
The COPPER team found quite a bit of variation between geographic regions in Medicare spending for breast cancer screening, ranging from $40 to $110 per beneficiary. Much of this difference in costs was because of the use of newer, more expensive screening methods in higher-cost areas.
Surprisingly, the Yale COPPER team found that although screening costs varied more than two-fold across geographic regions in the US, there was no evidence linking higher expenditures to actual health benefits for the women living in the high-cost regions.
In other words, there was no relationship between screening expenditures and detection of advanced cancers.
Recent guidelines from the United States Preventive Services Task Force conclude that there is insufficient evidence about the effectiveness of breast cancer screening for women aged 75 years and older.
Shockingly, the COPPER team found that over $400 million is being spent annually on screening Medicare beneficiaries in this age group alone.
Breast cancer screening can save lives, true. But just as clearly, more studies are needed to better identify which women will truly benefit from screening, and how to screen effectively and efficiently.
No woman wants to undergo testing if it is likely to cause more harm than good. Not only that, the US healthcare system simply can’t afford to spend hundreds of millions of dollars on breast cancer screening programs without proven evidence of their effectiveness.