Breast Cancer: To Screen Or Not To Screen

Will new evidence lead to earlier mammograms?

Women in their 40s who are unsure about whether to get mammograms can be forgiven their confusion. The medical community seems to be equally at sea: The debate has gone back and forth for years. Now, taking on the National Cancer Institute (NCI), which does not recommend regular mammography for low-risk women in their 40s, the American Cancer Society (ACS) on Mar. 24 called for yearly screening.

If women follow the ACS recommendation, it will represent a big change--medically and financially. Experts say the up-front costs of mammography for women in their 40s could run as high as $850 million. In terms of "cost per year of life saved"--a figure used to determine the cost effectiveness of a treatment--having an annual mammogram from age 40 to 79 would cost $18,800 per year of life saved, well above the $10,000 for coronary bypasses. In the long run, though, added screening could make economic sense if enough cancers are detected and treated early.

Indeed, some businesses don't have to be convinced of the cost-effectiveness of early screening. Zeneca Pharmaceuticals bought its own mammogram machines and offers all women employees annual screening at the workplace. It figures it may have saved $1.1 million over seven years by detecting and treating a dozen cancers early. Adolph Coors Co. and Rite Aid Corp. also have on-site programs.

Even some cost-conscious insurers are starting to cover early screening. U.S. Healthcare, for one, will cover annual mammograms for women 40 to 50 if a woman is high risk or if a physician requests it. But U.S. Healthcare and its peers are taking a wait-and-see approach on yearly mammograms for all women in their 40s.

Several studies led the ACS to change its recommendation, including a recent Swedish study that showed a 44% reduction in deaths among women 40 to 49 who have yearly tests--a definite benefit. It's too bad for women the medical community isn't equally clear.

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