In 2009, the US Preventive Services Task Force created guidelines recommending biennial mammography screening for women between the ages of 50 and 74. And now, scientists suggest that following this guideline would be equally effective and save the US health care system $4.3 billion a year.
The researchers, led by Dr. Laura J. Esserman, professor of surgery and radiology at the University of California-San Francisco (UCSF), also support other aspects of the US Preventive Services Task Force (USPSTF) guidelines, which recommend women between the ages of 40 and 49 are screened according to other risk factors and women over 75 are screened depending on presence or absence of other diseases.
The team says around 70% of women in the US were screened for breast cancer in 2010, costing around $7.8 billion.
While some women are screened annually, some are screened biennially and others are screened on an "irregular basis."
Published in the journal Annals of Internal Medicine, the study employs three possible screening strategies with simulated models:
- Following Amercian Cancer Society recommendations: annual screening of 85% of women aged 40-84; annual estimated cost at $10.1 billion
- Following guidelines from many European countries: biennial screening of 85% of women aged 50-70; annual estimated cost $2.6 billion
- Following USPSTF recommendations: at a screening rate of 85%; annual estimated cost at $3.5 billion.
The team found that the largest factors for cost were screening frequency, percentage of women screened, cost of mammography, percentage of women screened with digital mammography and percentage of mammography recalls.
Dr. Esserman notes that the "USPSTF guidelines are based on the best scientific evidence to date," adding that we need "a better way to assess breast cancer risk and implement a more risk-based approach to screening."
'Billions saved could be used for women's health'
The researchers say screening normal-risk women biennially could save billions and "makes sense" from the viewpoint of women's health.
The topic of reducing screening appointments has understandably been a controversial one. However, the researchers note that apart from high-risk groups, less frequent screening has been proven as effective, which is why they wanted to look into the cost differences between screening policies.
Dr. Esserman says that "annual screening is associated with a greater likelihood of false positive results, which have an adverse impact on women's well-being and quality of life."
"From the viewpoint of women's health," she adds, "the USPSTF screening recommendations make sense."
Dr. Cristina O'Donoghue, now from the University of Illinois-Chicago, but who was with UCSF during the study, says the billions saved could be used toward women's health:
"We could increase women's participation in screening, improve routine assessment of breast cancer risk and referral services for women at high risk, offer better genetic counseling for women with a family history of breast cancer and work on improving the quality of screening, with an emphasis on higher-quality mammography read by specialized mammographers."
'National organizations have been hesitant to talk about costs'
In a linked editorial to the study, Drs. Joann G. Elmore and Cary P. Gross, from the University of Washington and Yale School of Medicine, applaud the study authors for "meticulously assessing the total cost of breast cancer screening in the US."
They add that though "there is often cause to be skeptical about simulation models because results are based on numerous assumptions," they found the study "to be reasonable and conservative."
However, they point out a few topics not covered by the study:
"Beneficial patient-centered issues, such as the reassurance women feel after being screened, the early detection of lesions that allows for more treatment options, and the potential to save lives, are beyond the scope of the accompanying economic modeling study. However, they should be considered."
Drs. Elmore and Gross emphasize that other countries do not screen women annually, such as the UK, which invites women to be screened every 3 years, starting at 50 years of age.
"Women and their providers do not know the costs associated with breast cancer screening," they add, "and national organizations have been hesitant to discuss this issue."
Medical News Today recently reported on a study that suggested recommendations on breast abnormalities need to be revised.