A new report has fueled the debate over rising medical costs linked to routine breast cancer screenings during the past five years. The latest report estimates those costs are much higher than previously documented.
A Memphis physician says the reasons for the high costs are readily apparent, as are the ways to reduce the costs.
The study published in Health Affairs, a national, peer-reviewed healthcare journal, reported last month that the U.S. spends $4 billion annually on tests that produce false-positive mammograms and the over-diagnosis of breast cancer.
The increased use of digital mammograms, insufficient professional experience and subjectivity are the potential causes, according to Memphis breast-care specialist Christine Mroz, MD. She says doctors and patients can do several things to lower medical costs and the chances of receiving a false-positive reading from a mammogram.
The study, performed by a research fellow at Boston’s Children’s Hospital and a Harvard Medical School professor, concluded that among the surveyed women, 11 percent received a false-positive result from a mammogram. That means about 3.2 million women nationally would get a false-positive result each year, resulting in $2.8 billion in spending, according to the study.
“There has been an increase in the number of false positives in the last five years or so because they are being viewed digitally,” Mroz said. “When the mammogram is magnified four times its actual size, something may look abnormal when it isn’t. If you don’t know what you are specifically looking for, it can result in a positive reading to be on the safe side.”
Mroz is a breast surgeon with over 45 years of experience in breast care. She is the founding physician of the Mroz-Baier Breast Care Clinic, which opened in Memphis in 1994. Since then the clinic has seen more than 45,000 patients. Mroz and another breast
surgeon, Ron Mattison, MD, see 25 to 30 patients per day. The clinic is one of the few that still performs film screen mammograms, which use X-ray film.
“Digital screenings, where the results are viewed on a computer, are now the preferred method because an office doesn’t have to store film, so the cost is lower,” Mroz said.
According to Mroz, there is a learning curve associated with reading digital mammograms. Doctors must relearn how to view them.
“Clinics have used film screening since the 1970s, so digital mammography is relatively new,” she said. “All systems will be digital in the future, and I think professionals will get up to speed in reading them. My advice for the people reading them is to view them at actual size instead of magnifying them.”
Another factor that can generate false-positive results is that the radiologist viewing the screen may not be specialized in reading mammograms.
“Some clinics have rotating radiologists who are reading the mammograms, and they aren’t as up to speed on knowing what abnormalities to look for,” Mroz said. “You want the same mammography radiologist looking at the patient’s mammograms and ultrasound if possible.”
According to Mroz, mammography radiologists receive additional training and must be board-certified according to the 1992 Mammography Standards Act. These radiologists must view a certain number of mammograms per year and take continuing education credits to stay certified.
“Experienced interpreting physicians are viewing mammograms at the larger breast clinics in the Memphis area,” Mroz said.
She takes this one step further at her clinic.
“Each physician personally views the patient’s mammogram, ultrasound and biopsy results,” she said. “We also exam the patient and perform the surgery. We are a part of the entire process from day one.”
Mroz recommends that patients seeking a mammogram can decrease the chance of receiving a false-positive result by going to a clinic that specializes in mammography and inquire if a mammography radiologist reads the results.
“Patients need to make sure they are going to a place where the physician is experienced in reading mammograms,” she said. “Also, it’s best if the patient goes to the same office each year to receive a mammogram. That office has the patient’s previous mammograms on file for comparison. If a patient switches doctors, she should pick up her previous X-rays and take them to her new doctor.
“False positives can generate additional tests and in some cases surgeries, which can be expensive. That is another reason you want someone experienced viewing the results. An experienced Interpreting Physician would know by the shape and distribution of a calcification if it looks cancerous. The person would be able to determine whether to biopsy it immediately or wait six months to see if it changes.”
Mroz stresses that in many cases it is safe for doctors to monitor a calcification for six months before performing a biopsy.
“Eighty percent of calcifications are not cancerous,” she said. “Things do not progress that quickly, especially in micro calcifications. A patient does not go from stage zero to stage three in six months. Six months is a perfectly safe time period to wait, and a patient’s life is not in danger during that time frame. The treatment for the patient is exactly the same.”
The American Cancer Society recommends yearly mammograms for women beginning at age 40, while the U.S. Preventive Services Task Force, an independent group of national experts in prevention and evidence-based medicine, recommends a biennial screening to be done at age 50. The study found that women 40 to 49 were more likely to have a false-positive mammogram compared to women over 50.
“There is a trend in some states, such as California, where professionals are re-evaluating whether to recommend a yearly mammogram at age 40,” Mroz said. “My professional opinion is that women ages 40 to 70 should still get a mammogram screen annually, but also perform a self-exam in the shower once a month. Self-exam is still the best way for women under age 40 to know something is abnormal.”
A mammogram is the best method to catch cancer in its early stages, Mroz said. More than 62 percent of women ages 40 to 49 get an annual mammogram, and more than 72 percent of women 50 to 59 get a regular screening, according to the National Center for Health Statistics.
“My hope is that in 10 years we won’t have to perform mammograms,” she said. “There is work being done with genes that hopefully will be able to predict a patient’s risk, so that mammograms are done selectively for only high-risk patients.”
Mroz suspects something as simple as a saliva specimen or a blood test might be able to detect whether a patient is prone to having breast cancer.
“We could experience a new treatment in breast cancer in the next decade,” she said. “Pin-pointing cancer genes means more targeted medicines, less surgery and less scared patients.”
RELATED LINK:
http://www.breastcareclinic.com
