February 4, 2104 — According to the American College of Radiology and Society of Breast Imaging, the recent article (O’Donoghue et al) regarding costs of national breast cancer screening published in the Annals of Internal Medicine (AIM) is misleading and provides an incomplete picture of costs and benefits of breast cancer screening programs.
The authors state there is little outcome difference between using the United States Preventive Services Task Force (USPSTF) and American Cancer Society (ACS) screening guidelines, and indicate that using the ACS guidelines therefore adds unnecessary costs. However, an analysis published in the American Journal of Roentgenology showed that, if USPSTF breast cancer screening guidelines were followed, approximately 6,500–10,000 additional women each year in the U.S. would die from breast cancer.
One of the AIM author’s references shows a 70 percent improvement in the number of years of life gained and mortality reduction when ACS guidelines are followed. Another demonstrates that 42 percent more life years and lives would be saved with annual digital mammography screening compared to screening every other year. 2009 USPSTF data show the cost per year of life saved is well under the $75,000 to $100,000 per quality-adjusted life year that is considered a cost-effective intervention. More than 40 percent of the years of life lost to breast cancer are in women who are diagnosed in their forties. Basing screening recommendations on risk profiles is a limited strategy, since 75 percent of breast cancer occurs in women of average risk.
Responders say the financial analysis is flawed because it used only the cost of screening and did not include the costs associated with failure to screen. Less frequent screening can result in delayed diagnosis and costs such as morbidity, lost income, treatment of metastatic disease and death, which were not considered in the analysis.
A scientific article showed the cost of a single case of metastatic breast cancer treatment as $250,000. The cost in lost productivity of one person dying from breast cancer has been shown to be $223,000. The cost of not screening the additional women who would die each year if USPSTF breast cancer screening recommendations were implemented could be as high as $4.7 billion annually. This may only scratch the surface of the true costs of reduced screening.