$5 Billion a Year on Breast-Cancer False Alarms: Is It Worth It?

Just yesterday, one of my dear running buddies and closest friends told me a story that made me think. She had just had her yearly breast screening, which included both a mammogram and an ultrasound. The ultrasound is necessary due to the fact that her breast tissue is dense and prevents the radiologist from seeing things clearly enough with the mammogram alone.

Her ultrasounds came back with suspicious findings on both breasts, so she was asked to come back a week later for a repeat ultrasound with a radiologist present. Once again, there was a suspicious mass in her left breast. She could not feel it, but the doctor recommended a biopsy.

She intends to have the biopsy next week, but this sequence of events made me remember that just a month ago another of my friends went through the exact same series of tests and biopsies. Her biopsy came back completely normal.

Financial Costs of False-Positive Mammograms

This scenario is not unique to my two friends, I can assure you. A new study published in Health Affairs estimates that the United States spends $4 billion per year on medical costs for women in their forties whose mammograms lead to false alarms, or who have treatment for breast tumors that were unlikely to cause problems.

Specifically, the study outlines the cost breakdown this way:

1.$2.8 billion due to false-positive mammograms

2.$1.2 billion due to the treatment of breast tumors that grow slowly or not at all

These costs are therefore referred to as unnecessary. But are they?

Benefits of Breast Cancer Screening

Breast cancer is the second most common cause of death from cancer among American women, leading to nearly 41,000 deaths per year. Because breast cancer is easier to treat if detected early, annual mammograms starting at age 40 have long been considered standard preventive care.

Recently, however, differing views are emerging on regular screening for women in their forties, similar to the medical debate about prostate cancer screening for men.

The Health Affairs study makes the argument that false-positives and overdiagnosis are not only costly, but also expose women to the risks of additional imaging tests or biopsies, not to mention unnecessary psychological distress.

One of the study’s authors, Harvard Medical School professor Kenneth Mandl, MD, stated, as reported by the Associated Press, “The fact that this is not only a problem, but a very costly problem, we hope will accelerate the attempts to fix the screening practices.”

According to Richard Wender, MD, who leads the prevention, detection, and patient-support efforts at the American Cancer Society (ACS), the practices don’t need fixing. He believes that the study (which found that women in their forties were more likely to have a false-positive compared to women in their fifties) failed to take a balanced approach.

“I strongly feel that every study that looks at the downside of any screening test has to be balanced with the benefits,” he said, adding, “There is no debate about the benefits of mammography,” reported the Associated Press.

I agree. The subjective nature of mammogram analysis has been partially addressed through a standardized risk category system called BI-RAD. This system was put in place to help radiologists and other physicians decide how to manage cases.

Also, I think that more sensitive mammography techniques, such as 3D mammography, will only cut down on questionable and suspicious findings by making breast tissue easier to visualize.

It is important to put the costs associated with breast cancer diagnosis into perspective. Consider the fact that our country’s total Medicare budget is estimated at $6.4 trillion. One-quarter of that amount is spent on end-of-life care, and has been for the last 35 years.

Much of this spending could be reduced or eliminated if patients were simply asked about their wishes in this regard. Clearly, breast cancer-related medical expense is hardly the primary cause of our country’s burgeoning healthcare costs.

Young mothers in their forties don’t want to hear statistics indicating that they have an 85 percent chance of cure (considered stage 2 breast cancer) when they could have a much more optimistic number, such as nearly 99 percent chance of cure (stage 0 or stage 1). Oftentimes, that 14 percent difference can be attributed to early detection and less invasive, protracted, or costly treatments.

So before we consider eliminating procedures and practices used for breast cancer diagnosis, we should carefully consider what we stand to lose by doing so.