Use of Unproven Mammography Tool Soars with Medicare

(Ivanhoe Newswire) -- Ever wondered just how much influence the political system can have on medical practice? A University of California, Davis physician-researcher recently found that use of a largely unproven mammography screening tool has surged since Medicare began covering its cost.

Joshua Fenton, assistant professor in the UC Davis Department of Family and Community Medicine, and colleagues from the University of Washington and University of Minnesota, examined the use pattern of computer-aided detection (CAD) -- a tool to help radiologists interpret mammograms, since Congress mandated 10 years ago that Medicare pay for it.

Fenton found that CAD use jumped from 5 percent in 2001, when Medicare began covering it, to 27 percent in 2003, the most recent year for which data was available. Extra mammography fees for CAD cost Medicare an estimated $19.5 million in 2003 alone. Actual costs were probably greater because the technology has been associated with high recall rates and greater use of diagnostic tests such as breast biopsy.

The increase in CAD use occurred even though "systemic reviews point to uncertainty regarding whether CAD has a clinically important impact on key breast cancer outcomes," Fenton was quoted as saying.

The assurance of Medicare coverage was key to marketing CAD to hospitals and health care facilities and was the result of intense lobbying of Congress for approval of CAD as a covered benefit.

"This illustrates how industry and government interact to determine the course of health care practice, and it's not really guided by science," said Fenton. "This is a case in which expensive technology gets widely adopted in clinical practice before it is proven effective."

CAD software analyzes the mammogram image and marks areas for radiologists to review. In a previous study of more than 200,000 women who had mammograms, Fenton and colleagues found that when CAD was used, 32 percent more women were recalled for additional tests and 20 percent more women had a breast biopsy. However, use of the software had no clear impact on the early detection of breast cancer.

"This argues that we need a way of evaluating technologies before we put them into practice," said Fenton. "The government has a huge stake in this. And once the train leaves the station, it's difficult to call it back."

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SOURCE: Archives of Internal Medicine, online, June 14, 2010