In 2009, the US Preventive Services Task Force (UPSTF) established guidelines recommending biennial mammography screening for women between the ages of 50 and 74. While today, researchers suggest that following this recommendation would be just as effective and save the US health care system $4.3 billion a year.
The researchers, headed by professor of surgery and radiology at the University of California-San Francisco (UCSF), Dr. Laura J. Esserman, also support other facets of the USPSTF guidelines, which advise women between the ages of 40 and 49 are screened based on other risk factors and women over 75 are screened according to the presence or absence of other diseases.
The team mentions around 70% of women in the US were screened for breast cancer in 2010, which approximately cost $7.8 billion.
While some women are screened yearly, some are screened biennially and others are screened on an "irregular basis."
Published in the journal Annals of Internal Medicine, the study uses three possible screening methods with simulated models:
1. Following Amercian Cancer Society recommendations: annual screening of 85% of women aged 40-84; annual estimated cost at $10.1 billion
2. Following guidelines from many European countries: biennial screening of 85% of women aged 50-70; annual estimated cost $2.6 billion
3. Following USPSTF recommendations: at a screening rate of 85%; annual estimated cost at $3.5 billion.
The team discovered that the largest components for cost were screening frequency, percentage of women screened, cost of mammography, percentage of women screened with digital mammography and percentage of mammography recalls.
"USPSTF guidelines are based on the best scientific evidence to date. We need a better way to assess breast cancer risk and implement a more risk-based approach to screening," notes Esserman.
The subject of diminishing screening appointments has reasonably been a controversial one. Yet, the researchers note that apart from high-risk groups, less frequent screening has been proven just as effective, which is why they sought to look into the cost differences between screening policies.
"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," said Esserman.
"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 time of the study, posits that 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."
In an accompanied editorial to the study, Drs. Joann G. Elmore and Cary P. Gross, from the University of Washington and Yale School of Medicine, praise 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 issues that go uncovered in 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."
Elmore and Gross stress 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."