Costly breast cancer screenings don't add up to better outcomes

Breast cancer-screening mania was originally pushed by the medical-industrial complex. Now the forces behind ObamaCare want it reined in.

Yale media release below.


Costly breast cancer screenings don’t add up to better outcomes

Even though Medicare spends over $1 billion per year on breast cancer screenings such as a mammography, there is no evidence that higher spending benefits older women, researchers at Yale School of Medicine found in a study published Online First by JAMA Internal Medicine, a JAMA Network publication.

Led by Cary Gross, M.D., associate professor of internal medicine at Yale School of Medicine and director of the Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center at Yale, the study sought to provide a comprehensive understanding of breast cancer expenditures that incorporate the cost of screening and associated work-up, as well as treatment. They assessed overall national costs, as well as variation in costs across geographic regions.

The Yale COPPER team calculated Medicare expenditures for breast cancer screening and treatment in 137,274 female Medicare beneficiaries who had not had breast cancer before 2006, and followed them for two years to observe screening, breast cancer incidence, and associated cost.

The team found substantial variation across geographic regions in Medicare spending for breast cancer screening – ranging from $40 to $110 per female Medicare beneficiary. The majority of the difference in costs was due to the use of newer, more expensive screening technologies in the higher-cost areas.

“Although screening costs varied more than two-fold across geographic regions, there was no evidence that higher expenditures were benefiting women living in the high-cost regions,” said Gross, who is a member of Yale Cancer Center. “Specifically, there was no relation between screening expenditures and the detection of advanced cancers.”

Recent guidelines from the United States Preventive Services Task Force have concluded that there is insufficient evidence regarding the effectiveness of breast cancer screening for women age 75 years and older. The COPPER team found that over $400 million is being spent annually on screening Medicare beneficiaries in this age group.

“We need further studies to identify which women will benefit from screening, and how to screen effectively and efficiently,” said Gross. “In some instances, breast cancer screening can save lives. But no woman wants to undergo testing if it is likely to cause more harm than good, and no health system — particularly ours — can afford to spend hundreds of millions of dollars on screening programs without evidence to support them.”


8 thoughts on “Costly breast cancer screenings don't add up to better outcomes”

  1. Consumer-Driven Healthcare plans do that extremely well. It’s cheaper in every way than an equivalent traditional plan, but by making you pay in cash for your bills instead of paying the insurance company to pay them gives strong incentives to reduce costs.

    Of course, that makes too much sense.

  2. The nasty thing about this who schenanigan is that reforms were needed, and Obama’s omnibus does include some of them (the banning of discriminatory pricing due to lack of insurance being the most prominent). They would have been much more effective if passed on their own without these massive, costly overhauls

  3. Johan, if it was dollars saved vs. lives lost, you’d be right to be outraged. But in this case the study (and many, many others) simply shows that much of the money spent on screening is wasted… not because it claims that the money saved is worth the extra lives lost, but because NO LIVES ARE ACTUALLY SAVED by spending the money in the first place:

    “Specifically, there was no relation between screening expenditures and the detection of advanced cancers.”

    Since there is zero benefit to the higher expenditure, that money is therefore “wasted” and better spent somewhere else, on some other aspect of those patients’ healthcare, e.g.

    (Most of the heart disease screens out there are even worse, just fyi.)

  4. Alex Avery: Breast cancer is somewhat more serious than a leaking head gasket in your car engine. Calculating mere dollars like the Yale people do is inhuman! You are the voter, vote for a sensible healthcare. There are other percentages than 0 % and 100 %, you know. I had my hip joint replaced in a regional hospital for a modest 400 $ by the best surgeon for 500 miles around by waiting six months (no big deal, nothing had broken, just worn). I could have had it done in a month privately for 10 000 $. With the taxes I pay (six-figure) I have a good conscience taking the cheaper alternative. On the other hand, I show my heart 2 times a year since 10 years to a top-notch cardiologist privately at 500 $ a year including full lab tests. Due to the flexible interplay between national and private healthcare he has immediate access to a top city-operated clinic with all the gear needed if anything goes wrong.
    Imagine the Nebraska farmer with a wife with breast cancer and four screaming kids. His farm isn’t worth the money needed to save her life without national healthcare. Real life sickness is a bit different from all the TV series stuff!

  5. We already had scientific data indicating that most of these screenings were less than effective (being generous) at producing long-term health benefits, and we had it well before Obamacare became the law of the land.

    As others have pointed out, though, only now that the government will be responsible for rationing providing our health care do we see reasons for reducing the frequency of these (lawsuit) preventive medical procedures publically disseminated in forums likely to penetrate the public’s consciousness.

    Tort reform would have done more for the common person’s medical bills than O-care, but as I’m always saying, it’s about the people in charge, not the people affected…

  6. Just wait, the list of worthless medical screenings/interventions is going to grow exponentially now that “Da Govmint” (it’s “their” money, right?) is paying for healthcare. Watch.

    But the backlash is going to be considerable. When a bureaucrat makes the decision not to screen (or use more advanced screening tech), people resent the interference because they aren’t paying for it. When the patient pays, and THEY decide not to screen, they don’t resent it because it was an informed decision THEY made themselves.

    That, and the fact that EVERY aspect of our lives is now subject to community oversight (due to collective costs), is the reason so many of us are 100% against national healthcare.

  7. It’s about time this issue was address. Maybe Obamacare will have a few benefits after all. Still isn’t worth though.

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