WASHINGTON – Sharpening a medical debate about the costs and benefits of cancer screening, a new report estimates that the U.S. spends $4 billion a year on unnecessary medical costs due to mammograms that generate false alarms, and on treatment of certain breast tumors unlikely to cause problems.
The study published Monday in the journal Health Affairs breaks the cost down as follows: $2.8 billion resulting from false-positive mammograms and another $1.2 billion attributed to breast cancer overdiagnosis. That’s the treatment of tumors that grow slowly or not at all, and are unlikely to develop into life-threatening disease during a woman’s lifetime.
The cost estimates cover women ages 40-59.
Breast cancer is the second most common cause of death from cancer among American women, claiming nearly 41,000 lives a year. Annual mammograms starting at age 40 have long been considered standard for preventive care, because cancer is easier to treat if detected early. But recently there’s been disagreement about regular screening for women in their 40s. It parallels the medical debate about the pros and cons of prostate cancer screening for men.
Study authors Mei-Sing Ong and Kenneth Mandl say their findings indicate that the cost of breast cancer overtreatment appears to be much higher than previously estimated.
Ong is a research fellow at Boston Children’s Hospital and Mandl is a professor at Harvard Medical School.
But another expert called the study one-sided.
“There was no attempt to balance the costs with the benefits,” said Richard Wender, who heads prevention, detection and patient-support efforts at the American Cancer Society. “I strongly feel that every study that looks at the downsides of any screening test has to be balanced with the benefits.”
The American Cancer Society recommends yearly mammograms for women starting at age 40, while a government advisory group – the U.S. Preventive Services Task Force – recommends that regular screening begin later, at age 50. The study found that women ages 40-49 were more likely to have a false-positive mammogram, compared to women in their 50s.
Wender questioned the assumptions behind the new study, saying that the authors made a “very selective choice of estimates” for the rates of false positives and overdiagnosis.
“There is no debate about the benefits of mammography,” he said.
The study was based on billing data from a major U.S. insurer, encompassing more than 700,000 women ages 40-59 in all 50 states, from 2011 through 2013.
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