Screening Mammography: Costs & Benefits

Introduction:

The costs of breast cancer care are spiraling out of control. There is an urgent need to implement programs that will lower costs and reduce breast cancer mortality rates. The most effective strategy to accomplish both goals is to provide universal access to mammographic screening programs. When breast cancers are detected on screening mammograms the probability of a cure approaches 100% (Ref.1-2).

Despite the proven value of mammographic screening, challenges remain. A recent study estimated that 20% of breast cancers were not detected on standard mammographic screening (Ref. 3). Recent studies have demonstrated that AI-assisted mammography can detect a high percentage of breast cancers that are missed on the standard mammographic screening (see internal link: breast density). A recent study reported that AI-assisted mammograms detected 79% of breast cancers that were not detected on the standard screening mammogram (Ref. 4). This improvement in diagnostic accuracy has the potential to markedly improve breast cancer survival rates to reduce the costs of care.

 

Overview of Costs:

The yearly cost of breast cancer care in the USA is approximately $30 billion which is the highest treatment cost of any other cancer (Ref. 5). In addition to the national cost of breast cancer care, there can be major out-of-pocket expenses for the individual patient (Ref. 6-8). It is estimated that 70% of breast cancer patients are worried about their ability to afford medical care (Ref. 9). A recent study concluded that breast cancer patients were three times more likely to undergo bankruptcy than women who were not diagnosed with breast cancer (Ref. 10). In addition to the financial burden associated with being diagnosed with breast cancer there is an emotional burden to the patient and her family members (Ref. 11-13).

Another major cost issue is the high rate of negative breast biopsies. It is estimated that the yearly cost of unnecessary breast biopsies is in the range of $4 billion (Ref. 14). AI-assisted mammography has the potential to markedly reduce the rate of unnecessary breast biopsies (see internal link: Artificial Intelligence).

 

Lifetime Cost of Care: Early vs. Delayed Diagnosis

 

Lifetime cost of care: Early Detection:

When breast cancers are detected on screening mammography in women who have no breast symptoms the long-term survival rates are high and recurrence rates are low. In most cases, mastectomy can be avoided, and the cosmetic results are typically excellent. We estimate that the lifetime cost of care for women who are diagnosed with early-stage breast cancer is in the range of $50-$100 thousand (Ref. 15).

 

Lifetime cost of care: Delayed detection:

The lifetime cost of care for women who have breast symptoms (such as a breast lump or bloody nipple discharge) at the time of diagnosis is much higher than the cost of care for women whose cancer was detected on the screening mammogram. These women are more likely to need aggressive surgery, radiation therapy, and chemotherapy (Ref. 16). Despite the initial aggressive therapy, these women are at an increased risk of developing a recurrence of their breast cancer which adds to both the emotional and financial costs of care.

Recent advances in breast cancer treatment have improved survival rates in many of these high-risk women, but they come at a high cost. Immunotherapy is now recommended for women who present with aggressive breast cancers. It is estimated that the cost of combined cost of chemotherapy and immunotherapy is in the range of $200 thousand per year (Ref. 17).

A current study is evaluating the potential benefit of CAR-T cells, a type of immunotherapy, to treat women with more advanced breast cancers. If this new therapy proves to be effective, the lifetime cost of care for women who meet the criteria for treatment with CAR-T cells will be in the range of $1 million (Ref. 18).

 

Summary:

There is an urgent need to provide women with universal access to AI-assisted screening mammography. In the short term, the cost of implementing such a program would be high. However, in the long run, universal access to AI-assisted mammography has the potential to detect early-stage breast cancers that have a high probability of cure and a low lifetime cost of care. We are convinced that investing in universal access to AI-assisted screening programs will prove to be a wise investment in women’s health.

 

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