Many Speculate Cost Behind Mammogram Guidelines

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When a government advisory panel last month suggested that women get mammograms less frequently, the reaction was fast and furious. Some people thought it must have been designed to cut costs. The scientists who made the recommendations insist money had nothing to do with their calculations. The question remains, however, would performing fewer mammograms save money?

STEVE INSKEEP, host:

Some critics of the new recommendation for mammograms think they know why experts suggested women wait until they're 50. Just one of the accusations came from the American College of Radiology. They said the government advisory panel suggested women get fewer mammograms as a way to cut costs. Republicans in Congress claim the same thing.

The scientists who made the recommendations insist money had nothing to do with their calculations, although the question still remains: Would performing few mammograms save money? We're going to try to set aside the politics and just look at the facts here. NPR's Tamara Keith is in our studios. Good morning.

TAMARA KEITH: Good morning.

INSKEEP: Remind us what the panel is calling for here, exactly.

KEITH: The panel is this U.S. Preventive Services Taskforce, and they're saying that women 50 and older should get mammograms to screen for breast cancer every two years instead of every one year, which has been the standard. And for women age 40 to 49, what they're saying is that they should talk to their doctors, that mammograms should no longer be routine in their 40s, but that they should carefully consider it. And many will probably decide to keep getting mammograms.

INSKEEP: But let's say that millions of women did actually follow this recommendation and get mammograms later and less often. Would that save money?

KEITH: Yes. But the panel did not look at that. They insist they didn't. And I had a hard time getting people to talk to me about this on tape, simply because of all the fallout from this for the last several weeks. So I was able to get a researcher to help me do the math, and what he said was that, you know, you do some rough calculations and you suppose all women in their 40s stopped getting mammograms, everyone else got fewer, say a mammograms cost $100, that would save around $2 billion on mammograms.

INSKEEP: If women actually all followed these recommendations, which they might not, what other cost would be affected?

KEITH: Well, there are biopsies. Over a decade, a woman has a one in three chance of having a false positive, which means a further workup, likely a biopsy.

One researcher calculated in a paper a few years ago that we spend a billion dollars a year on potentially unnecessary biopsies. And then the researchers I spoke to also said that there are real issues with over-diagnosis and overtreatment because we do a lot of mammograms, we catch a lot of slow growing cancers that may never have made people sick.

And so thousands of women may be getting mastectomies and chemo and radiation that didn't need it, who never would've gotten sick. If you add all those things up, it comes to about four to $5 billion dollars in possible unnecessary spending, though, compared to our nation's health care bill, it isn't a lot of money.

INSKEEP: So there are some possible savings on the table here. But aren't there also some possible costs if women get mammograms later and less often because there are some cancers that would be caught later and perhaps treatments that would have to be more extensive and women that would die?

KEITH: Yes. But this is also where the math gets very fuzzy, because even annual mammograms often don't catch the most aggressive cancers at an early stage. And delaying treatment of the slow growing cancers may not do any harm at all. So it's just incredibly hard to do the math on this, and the reality is that women aren't doing that kind of math.

For them, it's not about averages. This is our health we're talking about here. People don't make decisions based on probabilities. It's one person weighing out risks and benefits. And at least for people with insurance, they aren't even thinking about costs at all.

INSKEEP: NPR's Tamara Keith. Thanks very much.

KEITH: Thank you.

INSKEEP: To help make sense of the debate on mammograms and other health care issues, go to Shots, which is NPR's health blog. There, NPR's Julie Rovner decodes the Senate health care debate, and our science team outlines a famous brain autopsy that could help scientists better understand memory.

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