In 2010, about 70 percent of U.S. women were screened for breast cancer at a cost of $7.8 billion. Some were screened annually, some biennially and some on an irregular basis.
Dr. Laura J. Esserman, a professor of surgery and radiology at the University of California, San Francisco, said she and her colleagues compared the current picture of breast cancer screening with three simulated models: annual screening of 85 percent of women ages 40 to 84 at an annual estimated cost of $10.1 billion; biennial screening of 85 percent of women ages 50 to 70 at an annual estimated cost of $2.6 billion; and screening in accordance with U.S. Preventive Services Task Force recommendations, which the authors estimate would cost $3.5 billion per year at a screening rate of 85 percent -- while saving the United States $4.3 billion a year in healthcare costs.
"Over the last decade, in study after study, it has become very clear that -- apart from limited, specific high-risk groups -- biennial screening is as effective as annual screening mammography," Esserman, the study leader, said in a statement. "At the same time, 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. From the viewpoint of women's health, the USPSTF screening recommendations make sense.
"We can go one step further and learn who is at risk for what kind of breast cancer, and over time, further tailor screening by adjusting the age to start and frequency as well as include recommendations for prevention."
The task force guidelines, adopted in 2009, call for biennial screening for women ages 50 to 74. The guidelines suggest women age 40 to 49 be screened according to other risk factors, and women 75 and older screened depending on the presence or absence of other diseases.
"The USPSTF guidelines are based on the best scientific evidence to date," Esserman, who is director of the Carol Franc Buck Breast Care Center at the UCSF Helen Diller Family Comprehensive Cancer Care Center, said. "What we need now is a better way to assess breast cancer risk and implement a more risk-based approach to screening. We have demonstrated that the resources for doing this are already in the system. We should redirect them to learning, enabling change and improving outcomes."
The findings were published in the Annals of Internal Medicine.
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