Study Examines the Cost of Breast Cancer Screening in Older Women

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The issue of breast cancer screening in older women has been a matter of debate in recent years. In 2009, the U.S. Preventive Services Task Force (USPSTF) recommended that mammograms shouldn't be encouraged in women 75 years of age and older because they might not benefit from the screenings.

Several medical organizations, including the American Cancer Society, didn’t agree with these USPSTF’s conclusions and ignored the recommendations.

In an effort to learn more, researchers evaluated Medicare spending data for breast cancer screening and treatment in 137,274 women who were over the age of 65 and who had no history of breast cancer. More than half of the women in the study (58%) were at least 75 years of age.

The findings were published online January 7 in JAMA Internal Medicine in the study titled, “The Cost of Breast Cancer Screening in the Medicare Population.”

An evaluation of data from 2006 to 2007 showed that:

  • Medicare spends about $1 billion a year on breast cancer screening-related costs (screening plus the associated workup) for women over the age of 65. It spends $410 million of this amount on women 75 years of age and older.
  • In some regions of the country, women were more likely to be screened with newer and more expensive technologies, such as digital mammography and computer-aided detection. Screening costs were higher in regions where these newer technologies were being used.
  • Women in regions where screening costs were higher were up to 78% more likely than women in regions where costs were lower to be diagnosed with early-stage or in situ breast cancer. There was almost no difference, though, in the incidence of advanced breast cancer in the highest-cost vs. the lowest-cost areas.

The authors concluded that the new technology may have made it easier to detect cancer. But it also drove up costs, possibly without improving outcomes. (It might have detected slow-growing cancers that wouldn’t necessarily have progressed and needed treatment within the life span of an older woman.)

It’s very important to note that the study doesn’t actually address whether investment in more expensive technology improves breast cancer outcomes for older women. It was limited by the fact that the researchers only followed the patients for two years. The authors weren’t able to determine whether higher spending on screening led to better breast cancer outcomes in the long run.

Women who are aged 75 will live another 13 years on average. And many women aren’t average in terms of health status, life expectancy, or risk of dying of breast cancer or another disease. Nearly all experts would agree that screening doesn't make sense in an older woman who wouldn't want to be treated for breast cancer because of personal preferences or other health matters. Still, many women age 75 or older are in reasonably good health and would want to be treated should they be diagnosed.

Breastcancer.org believes that the importance of diagnosing breast cancer early, when it's most treatable, doesn't get any less important as a woman gets older. Regular screening mammograms make sense for older women who are in reasonably good health and who would want to be treated for breast cancer if diagnosed.

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