Cristina O'Donoghue, MD, MPH; Martin Eklund, PhD; Elissa M. Ozanne, PhD; Laura J. Esserman, MD, MBA
Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Cancer Institute or the National Institutes of Health.
Note: All authors had full access to all of the data in the study and take responsibility for the integrity of the data and accuracy of the data analysis. Each registry and the Statistical and Data Coordinating Center have received institutional review board approval for either active or passive consenting processes or a waiver of consent to enroll participants, link data, and perform analytic studies. All procedures are Health Insurance Portability and Accountability Act–compliant and all registries and the Statistical and Data Coordinating Center have received a Federal Certificate of Confidentiality and other protection for the identities of women, physicians, and facilities who are subjects of this research.
Acknowledgments: The authors thank the Breast Cancer Surveillance Consortium investigators, participating women, mammography facilities, and radiologists for the data they provided for this study. A list of the Breast Cancer Surveillance Consortium investigators and procedures for requesting Breast Cancer Surveillance Consortium data for research purposes are provided at: http://breastscreening.cancer.gov. They also thank Pamela Derish, MA, from the Department of Surgery at the University of California, San Francisco, for editing the manuscript and Karla Kerlikowske, MD, from the Department of Medicine and Epidemiology Biostatistics at the University of California, San Francisco, and Rebecca Hubbard, PhD, from the Group Health Research Institute and Department of Biostatistics at University of Washington, for reviewing the manuscript and giving valuable input.
Grant Support: This effort is part of the analysis proposed for breast cancer screening and prevention as part of the Athena Breast Health Network, a collaboration of the 5 University of California medical centers. Athena is supported by the University of California and Safeway Foundation. Data collection for this work was supported by a National Cancer Institute–funded Program Project (P01CA154292) and the Breast Cancer Surveillance Consortium (U01CA63740, U01CA86076, U01CA86082, U01CA63736, U01CA70013, U01CA69976, U01CA63731, U01CA70040, and HHSN261201100031C). Dr. O'Donoghue is funded in part by the University of Illinois at Chicago Eleanor B. Pillsbury Fellowship. Dr. Eklund is funded by the Swedish Council for Working Life and Social Research (FAS), project number 2012-0073. The collection of cancer data used in this study was supported in part by several state public health departments and cancer registries throughout the United States. For a full description of these sources, please visit www.breastscreening.cancer.gov/work/acknowledgment.html.
Potential Conflicts of Interest: None disclosed. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M13-1217.
Reproducible Research Statement: Study protocol: Available from Dr. O'Donoghue (e-mail, firstname.lastname@example.org). Statistical code: Available from Dr. Eklund (e-mail, email@example.com). Data set: Available from Drs. O'Donoghue and Eklund.
Requests for Single Reprints: Laura Esserman, MD, MBA, University of California, San Francisco Comprehensive Cancer Center, 1600 Divisadero Street, 2nd Floor, Box 1710, San Francisco, CA 94115; e-mail, Laura.firstname.lastname@example.org.
Current Author Addresses: Dr. O'Donoghue: University of Illinois at Chicago Department of Surgery, 840 S. Wood Street, Suite 518-E Chicago, IL 60612.
Drs. Eklund and Esserman: University of California, San Francisco Comprehensive Cancer Center, 1600 Divisadero Street, 2nd Floor, Box 1710, San Francisco, CA 94115.
Dr. Ozanne: The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, 35 Centerra Parkway, Lebanon, NH 03766.
Author Contributions: Conception and design: C. O'Donoghue, M. Eklund, E.M. Ozanne, L.J. Esserman.
Analysis and interpretation of the data: C. O'Donoghue, M. Eklund, E.M. Ozanne, L.J. Esserman.
Drafting of the article: C. O'Donoghue.
Critical revision of the article for important intellectual content: C. O'Donoghue, M. Eklund, E.M. Ozanne, L.J. Esserman.
Final approval of the article: C. O'Donoghue, M. Eklund, E.M. Ozanne, L.J. Esserman.
Statistical expertise: M. Eklund, E.M. Ozanne.
Obtaining of funding: L.J. Esserman.
Administrative, technical, or logistic support: C. O'Donoghue, M. Eklund, E.M. Ozanne, L.J. Esserman.
Collection and assembly of data: C. O'Donoghue, M. Eklund.
Controversy exists over how often and at what age mammography screening should be implemented. Given that evidence supports less frequent screening, the cost differences among advocated screening policies should be better understood.
To estimate the aggregate cost of mammography screening in the United States in 2010 and compare the costs of policy recommendations by professional organizations.
A model was developed to estimate the cost of mammography screening in 2010 and 3 screening strategies: annual (ages 40 to 84 years), biennial (ages 50 to 69 years), and U.S. Preventive Services Task Force (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).
Women aged 40 to 85 years.
Mammography annually, biennially, or following USPSTF guidelines.
Cost of screening per year, using Medicare reimbursements.
The estimated cost of mammography screening in the United States in 2010 was $7.8 billion, with approximately 70% of women screened. The simulated cost of screening 85% of women was $10.1 billion, $2.6 billion, and $3.5 billion for annual, biennial, and USPSTF guidelines, respectively. The largest drivers of cost (in order) were screening frequency, percentage of women screened, cost of mammography, percentage of women screened with digital mammography, and percentage of mammography recalls.
Cost estimates and assumptions used in the model were conservative.
The cost of mammography varies by at least $8 billion per year on the basis of screening strategy. The USPSTF guidelines are based on the scientific evidence to date to maximize patient benefit and minimize harm but also result in far more effective use of resources.
University of California and the Safeway Foundation.
O'Donoghue C, Eklund M, Ozanne EM, Esserman LJ. Aggregate Cost of Mammography Screening in the United States: Comparison of Current Practice and Advocated Guidelines. Ann Intern Med. ;160:145–153. doi: 10.7326/M13-1217
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Published: Ann Intern Med. 2014;160(3):145-153.
Breast Cancer, Cancer Screening/Prevention, Hematology/Oncology, High Value Care.
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