The Unnecessary Mammogram Tech That Costs the U.S. $400 Million a Year

A new study adds ammunition to researchers' argument that doctors should stop using software that's now used in 90 percent of mammograms.
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CAD markings on a mammogram. (Photo: Group Health Research Institute)

CAD markings on a mammogram. (Photo: Group Health Research Institute)

Talk about a waste of valuable dollars. Cancer-detection software now used in 90 percent of mammograms in the United States doesn't make any difference in how accurately radiologists are able to catch breast cancer, according to a new, large study of digital mammograms.

The software, called computer-aided detection (CAD), adds marks to breast tissue X-rays, which are supposed to help point out suspicious spots for radiologists. But this study, conducted by a team of researchers from various U.S. universities and the Group Health Research Institute in Seattle, reports that mammograms conducted with CAD weren't interpreted more accurately than those conducted without CAD. Plus, the study looked at a small group of radiologists who only sometimes used CAD, and found they were more likely to miss cancers when they did utilize the technology. The data came from the results of more than 625,000 mammograms conducted at 66 cancer centers in five states.

"Payments for ineffective services like CAD bloat our health care economy."

The study, which joins several others that have called CAD's usefulness into question, was released in the journal JAMA Internal Medicine, alongside an op-ed from cancer-screening researcher Joshua Fenton, who argues that Medicare should stop paying for CAD with mammograms. "Obviously, eschewing payments for CAD won't by itself bend the cost curve, but payments for ineffective services like CAD combine to bloat our health care economy," Fenton writes. The original study estimated adding CAD to mammography adds more than $400 million to the U.S.'s health-care spending every year.

For radiologists, this isn't necessarily breaking news. Since these studies started coming out in the late 2000s, scientists have been debating whether it's worth adding CAD to mammograms, the Seattle Times reports. Fenton himself led one of those studies. Published in 2007, his research found CAD reduced the accuracy of mammograms and might lead to unnecessary biopsies. Yet doctors kept using the technology, and insurance kept paying for it. Why?

Blame "auspicious political winds," Fenton argues. Congresspeople representing districts with major CAD-producing tech companies lobbied the U.S. Food and Drug Administration to approve CAD for mammograms and to have it covered by Medicare. Once Medicare approved the technology for coverage, private insurance companies, who "typically follow Medicare's lead," followed suit. The result? "We're spending a lot of money on something that sounded like a great idea—and just isn't," Group Health epidemiologist Diana Buist, who worked on the newest study, told the Seattle Times.

Officials at the Centers for Medicare and Medicaid Services told the Seattle Times they're reviewing the new data. Group Health, on the other hand, will likely stop paying for CAD with mammograms.

Quick Studies is an award-winning series that sheds light on new research and discoveries that change the way we look at the world.

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