Yale Study: Costlier Breast Cancer Screenings May Not Help Older ...

A new Yale study finds that newer and costlier screening methods for breast cancer in women age 65 and older don't necessarily bring better results, and suggests that the health care industry rethink screening procedures for women in that age group.

The study, published Monday in the journal JAMA Internal Medicine, finds that Medicare spends more than $1 billion on screening for breast cancer. Of that, $400 million is spent on screening for women age 75 and older, even though the U.S. Preventive Services Task Force says there isn't enough evidence that breast cancer screening provides much benefit for those women.

Dr. Cary Gross, who led the study, said the findings don't suggest that there is no benefit to screening these women but said that $400 million is a lot of money to spend on a procedure "given that we don't really know that it works or not."

Doctors shouldn't stop screening these women, he said, but they should think more about how they do it. For instance, women in the Medicare age group? 65 and older ? can vary greatly in their risk for breast cancer. The benefits of early detection also vary.

"The benefits of screening are directly related to your risks of developing breast cancer and your overall health," he said. "Women who have few other health problems and have a long expectancy would have far more to gain from screening."

Gross is director of the Cancer Outcomes, Public Policy, and Effectiveness Research Center at Yale.

The study also finds significant differences in screening costs, depending on the technology used. Screenings for Medicare patients ranged from $40 to $110 per patient. In areas that adopted more sophisticated ? and more expensive ? technology, such as digital mammography and computer-aided detection, women had higher screening costs but not necessarily a lower rate of cancer that has spread.

"As the field of radiology moves toward digital technology, it is important to note that digital mammography will frequently be the only option available," the researchers write in the study. "Higher costs associated with adoption of newer modalities may not necessarily yield superior outcomes."

For the study, the researchers looked at Medicare money spent on breast cancer screening and treatment of 137,274 female Medicare beneficiaries who had not had breast cancer before 2006. The researchers followed those patients for two years, noting the number of times they were screened, how many developed breast cancer and the costs of their screenings and treatment.

"My hope is that these findings will push the field not only to consider whether [screening is] effective, but also to consider some of the costs of it," he said.

Gross said he thinks the study's findings go along with a general trend of recent years in considering the importance of breast cancer screenings.

"We're just starting to have a tipping point," he said. "There are more skeptics about the benefits of screening and fewer zealots promoting more screening for all patients at all times."

Dr. Colin Begg, biostatistician at Memorial Sloan-Kettering Cancer Center in New York City, said it's a "useful study, with useful data." But Begg, who was not involved in the study, said he is wary that it downplays the importance of mammography.

"They've kind of overreached in implying that we're wasting our money in screening for this age group," he said. "I don't buy it."

But Dr. Otis Brawley, chief medical officer of the American Cancer Society, said the study correlates with "all my prejudices about American medicine." Medicare is too quick to adopt the latest technologies without enough study on how to use them. Digital mammography is good technology, he said ? so good that it often results in detecting tumors so small that they pose little risk. Once detected, however, they often get treated.

"Our wisdom on how to use these new technologies has not kept up with our abilities to develop these technologies," Brawley said.

Dr. Laura Esserman, director of the breast care center at the University of California in San Francisco, said the study's findings are consistent with her own research. Screenings are important, she said, but the health care industry has put too much faith in them.

"They make it something that it's not," she said. "You can't expect something from it that it can't deliver."

The more doctors learn about breast cancer, she said, the more it's apparent that the benefits of early detection vary significantly.

"Breast cancer's not one disease ? it's several diseases," she said. "And our understanding of screening has not kept up with our changing notions of what breast cancer is."

Source: http://www.courant.com/health/connecticut/hc-cancer-screen-study-0108-20130107,0,3599731.story

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