Reducing mammography screening frequency from annually to biennially among women aged 50 to 74 could save the healthcare system billions of dollars annually—and may actually allow physicians to end up screening more women compared with the current practice, according to the results of a study published in the Annals of Internal Medicine.
A mammogram is an X-ray of the breast. Screening mammography is performed in a woman without breast symptoms in order to detect breast cancer at an early stage when it is most easily treated.
Different groups of experts have reached different conclusions about when mammographic screening should begin and how often it should be performed. In 2009, the U.S. Preventive Services Task Force (USPSTF) issued guidelines recommending that routine screening of average-risk women begin at age 50 and be performed every two years. The recommendation set off a firestorm of controversy and many other groups continue to recommend that screening begin annually at age 40.
The recommendation for less frequent screening was based on a rigorous review from the Cancer Intervention and Surveillance Modeling Network—but now researchers are evaluating the cost savings of the approach as well. Researchers developed a computer simulation model to estimate the population-level cost of three U.S. screening strategies in 2010:
- Annual screening (for women aged 40 to 84 years)
- Biennial screening (for women aged 50 to 69 years)
- Screening according to USPSTF guidelines (biennial for those aged 50 to 74 years and personalized based on risk for those younger than 50 years and based on comorbid conditions for those 75 years and older).
The estimated cost of mammography screening in 2010 was $7.8 billion, with approximately 70 percent of women screened. The computer-simulated cost of screening 85 percent of women was:
- Annual Screening: $10.1 billion
- Biennial Screening: $2.6 billion
- USPSTF Guidelines: $3.5 billion
The largest drivers of cost were screening frequency, percentage of women screened, cost of mammography, percentage of women screened with digital mammography, and percentage of mammography recalls.
The researchers concluded that following the USPSTF guidelines would save $4.4 billion and screen 15 percent more women compared with the current screening practices. The guidelines are based on scientific evidence to maximize patient benefit and minimize harm—and they also result in huge cost savings.
O’Donoghue C, Eklund M, Ozanne EM, et al: Aggregate Cost of Mammography Screening in the United States: Comparison of Current Practice and Advocated Guidelines. Annals of Internal Medicine. 2014;160(3):145-153.