Digital mammography does not improve health enough to warrant its higher cost unless its use is limited to women under age 50 or women with dense breasts, according to a cost-effectiveness study comparing digital mammography and conventional film mammography for breast cancer screening.
The Dartmouth-led study found that health outcomes were equivalent between screening methods when all women were considered, but improved when digital was limited to younger women or women with dense breasts, resulting in cost effectiveness only in those subgroups. For the Medicare-aged population, digital mammography provided no apparent benefit and there was a hint that film mammography may be better for older women with non-dense breasts.
"It was important for us to learn how changes in breast cancer detection project into changes in life expectancy. Only by considering long-term health outcomes can we assess the value of the digital mammography relative to other health care interventions," said lead author Dr. Anna N.A. Tosteson, a Dartmouth Medical School professor of medicine and of community and family medicine. "What we found is that the higher cost of digital mammography is not justified by better health outcomes unless its use is directed to younger women or those with dense breast tissue," continued Tosteson, also of The Dartmouth Institute for Health Policy and Clinical Practice and the Norris Cotton Cancer Center at Dartmouth-Hitchcock Medical Center.
Data for the study were collected through the Digital Mammography Imaging Screening Trial (DMIST), which involved more than 42,000 women in the United States and Canada. The cost-effectiveness analysis determined work-up costs associated with digital versus film and projected long-term health outcomes using computer simulation methods. Based on Medicare prices, the cost of a digital mammogram is roughly $50 higher than the cost of a conventional film mammogram.
Although rates have been declining, breast cancer remains the second-leading cause of cancer death among women in the United States. The National Cancer Institute and others attribute a decrease in breast cancer deaths in part to an increase in detection through regular mammograms. Currently, about 33.5 million mammograms are conducted in the United States each year.
This research was published in the Jan. 1 issue of the Annals of Internal Medicine. In addition to Tosteson, authors on the paper were: Natasha Stout, Harvard School of Public Health; Dennis Fryback, University of Wisconsin; Suddhasatta Acharyya, Benjamin Herman, Lucy Hannah, all of Brown University; and Etta Pisano, University of North Carolina School of Medicine.
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