Posted On: August 4, 2014 by Patrick A. Malone

Digital Mammography Costs More and Isn’t More Effective

The U.S. is renowned for having the most expensive health care, but not necessarily the best. One reason for the high cost is our lust for fancy technological tools that might be best in some cases, but often fail to justify their cost. So says yet another study about digital mammography.

As reported by ModernHealthCare.com, researchers from Yale University School of Medicine found that although Medicare spent nearly $300 million more over seven years for high-tech mammography screenings, it didn’t seem to affect the rates for detecting cancer. The study, published in the Journal of the National Cancer Institute, said that annual Medicare spending for screening mammography increased from $666 million from 2001-2002 to $962 million from 2008-2009.

Several new digital imaging technologies were studied in two different groups for two-year periods. More than 137,000 women were involved between 2001 and 2002, and more than 133,000 between 2008 and 2009.

The number of women screened using digital imaging skyrocketed from 2 in 100 between 2001 and 2002, to nearly 3 in 10 between 2008 and 2009. The use of computer-aided detection showed a similar rise — from about 3 in 100 to 33 in 100 over those two periods. But the researchers found no changes in cancer detection rates.

The study authors joined the chorus of voices seeking more cost-benefit research of mammography screening for older women, especially given how fast expensive new technology is being developed. They used a Medicare database analyze use and costs of screening women 66 and older.

In an accompanying editorial, three medical thought leaders called out the use of whiz-bang technology just because we can. “Our enthusiasm for new technologies should not replace strong, consistent evidence that the benefits of the new technology outweigh the harms in a clinically important way.”

Ever since the U.S. Preventive Services Task Force recommended in 2009 that women who are not in a high-risk category for breast cancer needn’t get routine mammograms in their 40s, the most effective strategy for breast-cancer screening has remained debatable, said Modern Healthcare. Consensus still eludes breast cancer researchers about when to screen, how often and with what tools.

But just like hot, new smartphones, hot, new imaging technologies continue to draw attention. A study published earlier this summer in JAMA reviewed outcomes at 13 academic and nonacademic breast centers, and found that fewer patients were called back for additional imaging, and that there was a higher rate of breast-cancer detection when screening went beyond digital mammography to include a new 3-D breast-imaging technique called tomosynthesis.

Of course people were excited by the results, but others noted several limitations in the study, including the fact that it wasn’t a randomized trial. That’s the scientific gold standard, because if your trial subjects aren’t randomly chosen, they might share traits that aren't characteristic of a more representative population. Also, follow-up data weren’t available, so nobody could evaluate false-negative results.

Sometimes it’s not just the technology that needs scrutiny, but how it’s analyzed.

For more information generally about mammography, see our blogs on the topic.

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