SUMMARIES FOR PATIENTS

The Cost-Effectiveness of Mammography in Women Older than 65 Years of Age

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The summary below is from the full report titled "The Cost-Effectiveness of Screening Mammography beyond Age 65 Years: A Systematic Review for the U.S. Preventive Services Task Force." It is in the 18 November 2003 issue of Annals of Internal Medicine (volume 139, pages 835-842). The authors are J. Mandelblatt, S. Saha, S. Teutsch, T. Hoerger, A.L. Siu, D. Atkins, J. Klein, and M. Helfand, for the Cost Work Group of the U.S. Preventive Services Task Force.

What is the problem and what is known about it so far?

Breast cancer is the second deadliest cancer in U.S. women and it becomes more common as women age, so breast cancer is an important health issue for older women. Mammography involves special x-rays of the breast that can find breast cancer before it has spread. Mammography decreases breast cancer deaths in women 50 to 65 years of age, and the benefits of mammograms in this age group are thought to be worth the costs. However, whether the benefits of mammography in older women are worth the costs is unclear. While breast cancer becomes more common with age, so do other health conditions. Mammography screening might not be worth the costs in older women who are likely to die of another condition before breast cancer. Analyses that weigh the costs and benefits of mammography in women (cost-effectiveness analyses) have shown routine mammography to be cost-effective in women 65 years of age and younger, but studies have come to various conclusions about the cost-effectiveness of mammography in older women. "Cost-effective" means that the benefits are worth the costs.

Why did the authors do this review?

To review published analyses of the cost-effectiveness of mammography in women older than 65 years of age.

How did the authors do this review?

The authors reviewed studies published between January 1994 and March 2002 that looked at the costs and benefits of mammography. They identified the studies by searching electronic databases of the medical literature and contacting breast cancer experts.

What did the authors find?

The authors found 10 high-quality studies. These studies showed that performing mammography screening every 2 years in women from age 65 years to age 75 or 80 years would cost society $34,000 to $88,000 per year of life saved. The costs for older women were at the more expensive end of the spectrum. The term life-year refers to 1 year added to 1 patient's life: Five additional life-years could mean 1 patient lives 5 years longer or that 5 patients live 1 year longer. These costs were in range with the costs of other health care interventions that Americans accept as cost-effective. Two studies suggested that it might be more cost-effective to perform mammography in healthy women rather than women with other illnesses that are likely to shorten their lives.

What are the implications of this review?

Mammography screening every 2 years seems to be cost-effective in women older than 65 years of age who do not have other life-threatening conditions. However, further study of such factors as how breast cancer progresses in older women and the treatment preferences of this population are needed to better define the costs and benefits of mammography in older women.