False-positive mammograms, which suggest a woman has breast cancer when she actually doesn’t, cost the nation $4 billion a year, new research shows.
And a second study, also released Monday, shows that new treatments for women who really do have breast cancer may cost more, but they are helping them survive longer than older treatments.
The two studies, published in the journal Health Affairs, don’t say whether the costs either way are worthwhile, but they add some data to the debate about whether wider screening is worthwhile and to the discussion about health care costs in general.
For the mammogram study, Mei-Sing Ong and Dr. Ken Mandl of Boston Children’s Hospital examined false-positive mammograms and breast cancer overdiagnoses among more than 700,000 women aged 40–59 between 2011 and 2013.
“The costs associated with false-positive mammograms and breast cancer overdiagnoses appear to be much higher than previously documented,” they wrote.
“The costs associated with false-positive mammograms and breast cancer overdiagnoses appear to be much higher than previously documented."
During that time, they found 77,729 women, or 11 percent of those screened, got a false-positive mammogram that led to another mammogram, biopsy or other procedure to see if it really was breast cancer. The false-positives cost, on average, $852 per person.
False positives are common because what looks like a tumor on an X-ray may be a cyst, or it may be nothing at all. Sometimes growths just disappear, for reasons doctors don't quite understand.
Ong and Mandl also calculated what it cost to treat women for breast cancer that probably never would have caused them symptoms if it had not been detected via mammogram. Treating invasive breast cancer costs $51,837 on average, they found. They used other data that shows about 22 percent of people diagnosed with invasive breast cancer would never have suffered from it and added this to their calculation.
And they added in diagnoses of ductal carcinoma in-situ or DCIS, a precancerous condition. They used data that shows only 14 percent of women diagnosed with DCIS go on to develop cancer, which they say suggests 86 percent of cases are overdiagnoses.
Then they extrapolated their data to the U.S. population and factored in how many women get mammograms each year. “This translates to a national cost of $4 billion each year,” they wrote.
“The costs of harm associated with mammography screening are substantial and are much higher than previously documented. Such high diagnostic and treatment costs may tilt the balance to the point where screening appears relatively cost-ineffective,” they added.
Americans still debate the value of mammograms, and different groups of experts have different recommendations. No one disputes that they save lives but studies differ on whether the expense and anguish of a false-positive make it worthwhile for younger women at average risk to get screened every year.
Currently, the U.S. Preventive Services Task Force recommends that women over 50 only get a mammogram every other year, while the American Cancer Society recommends that women over 40 get one every year.
For the second study, Dr. Aaron Feinstein of the University of California, Los Angeles and Yale University School of Medicine and colleagues took apart the costs of treating women with breast cancer that has spread. Early breast cancer is easier to treat, but once it’s spread it becomes pricey and complicated.
They used Medicare information to compare 5,000 women treated with Stage II and Stage III breast cancer in the mid-1990s to nearly 5,000 treated 10 years later, in 2004 to 2006.
“In 2010, expenditures in the United States for breast cancer were approximately $16.50 billion."
In the 1990s, it cost an average of $12,000 to treat a case of stage II breast cancer and $18,000 to treat a case of stage III. Ten years later, these costs had risen to $17,000 for stage II and $32,000 for stage III . Much of this was because of new, targeted drugs such as Herceptin, which can cost $45,000 for a single course of treatment.
But the new treatments extended lives by a lot. In the 1990s, just 38 percent of women with stage III breast cancer lived five years after their diagnosis. By 2006, nearly 52 percent of women made it for five years or longer.
So why even discuss the matter? It’s important for planning costs, Feinstein said. “Medicare must cover new treatments once the Food and Drug Administration (FDA) approves them,” he and colleagues wrote.
“In 2010, expenditures in the United States for breast cancer were approximately $16.50 billion —higher than those for any other malignancy — and were expected to rise to $20.50 billion by 2020.”