Screening Mammography Costs Article Misleading, ACR Says

February 4, 2014

Cost of breast cancer screening mammography not as cut-and-dry as reported in a recent Annals of Internal Medicine article, according to the ACR and SBI.

An article discussing the costs of national breast cancer screening, published in the Annals of Internal Medicine, is misleading, according the American College of Radiology (ACR) and Society of Breast Imaging (SBI).

In the article, the authors describe their study that estimated the aggregate cost of mammography screening in the U.S. in 2010, and compared those costs with policy recommendations. The findings were that the estimated cost of mammography screening for that period, with approximately 70 percent of women screened, was $7.8 billion. The researchers reported that the simulated cost of screening 85 percent of women was $10.8 billion, $2.6 billion, and $3.5 billion for annual, biennial, and U.S. Preventive Services Task Force (USPSTF) guidelines.

The USPSTF guidelines recommend that mammography screening be changed to biennial screening, based on the idea that less frequent screening lessens potential negative effects.

The authors concluded that the USPSTF guidelines “are based on the scientific evidence to date to maximize patient benefit and minimize harm but also result in far more effective use of resources.”

In response to the article, the ACR and SBI stated that the article “provides an incomplete picture of the costs versus benefits of breast cancer screening and is misleading.”

The AIM article states that there was a 70 percent improvement in the number of years of life gained and mortality reduction when ACS guidelines are followed and that there was a 42 percent increase in life years, and lives would be saved with annual digital mammography screening compared to screening every other year. It also states that when one uses 2009 USPSTF data, the cost per year of life saved is well under the $75,000 to $100,000 per quality-adjusted life year that is considered a cost-effective intervention. Finally, more than 40 percent of the years of life lost to breast cancer are in women who are diagnosed in their forties. Basing screening recommendations on risk profiles is a limited strategy, since 75 percent of breast cancer occurs in women of average risk.

The ACR and SBI argued that this is a flawed analysis because the authors did not include costs associated with the failure to screen, such as the costs of morbidity, lost income, treatment of metastatic disease, death and other real financial implications associated with a diagnosis of advanced breast cancer due to less frequent screening were not considered in their analysis.

The groups stated that the cost of not screening the additional women who would die each year if USPSTF breast cancer screenings were implemented could be as high as $4.7 billion annually, as suggested by a recent scientific study that found that it costs $250,000 to treat one single case of metastatic breast cancer, and the cost in lost productivity of one person dying from breast cancer is $223,000.

The organizations countered that the goal of healthcare is to save lives, not dollars, and while a national conversation is welcome, accurate reporting is needed to do so.