The Mammogram Hustle

Article excerpt

There is no evidence digital mammograms improve cancer detection in older women. But thanks to political pressure, Medicare pays 65 percent more for them.

When patients at women's diagnostic of Texas began canceling their mammogram appointments in 2005, the staff had a good idea why. A Dallas hospital had recently put up a billboard beside the busy North Central Expressway announcing its new digital-mammography machine, and magazines and newspapers were full of ads for the devices, suggesting they were more effective at finding breast cancer than traditional film mammograms. So while the physicians at Women's Diagnostic were satisfied with film mammography, said Gerald Kolb, then chief knowledge officer at the clinic, once they began losing patients to the digital-mammography clinic they felt they had no choice. By 2006 they had replaced their film-mammography system with five digital units, for a total of $1.5 million. "We didn't want to spend the millions of dollars to make the conversion," Kolb says. "We had to."

Hospitals and clinics nationwide made the same calculation. They have spent billions buying digital-mammography units since 2000, when General Electric sold the first one in the U.S. Unfortunately, although the newer technology might be better at detecting breast tumors in younger women, it has not been proven to improve breast-cancer detection or health outcomes in women 65 and older, concluded a five-year study sponsored by the National Cancer Institute (NCI) and published in the journal Radiology in 2008. Yet despite the lack of evidence that digital mammograms are superior for older women, political pressure has forced Medicare to pay health-care providers more for them. That is one factor pushing more doctors to buy the digital systems and bill Medicare for their use, driving up health-care costs. "A lot of medical interventions have been oversold, and [digital mammography] is another one," says Dr. Russell Harris, a professor and preventive-medicine expert at the University of North Carolina School of Medicine. "The people who make the machines, who benefit by selling newer machines, have triumphed."

That triumph has come at a steep cost to the nation's health-care budget and, possibly, to women's health. An analysis of six years of Medicare billing data obtained by the Center for Public Integrity and The Wall Street Journal shows that despite its lackluster performance, digital mammography has become the new standard of care for women 65 and older. In 2003, Medicare paid about 426,000 digital-mammogram claims to physicians, clinics, and hospitals--4 percent of the total. In 2008, the latest year analyzed by the center, that number rose to almost 6 million, nearly 53 percent of the total. The shift has been expensive: Medicare pays $129 for a digital mammogram, but $78 for a standard film mammogram (though that can vary by state). As more screening centers switched to digital mammograms, Medicare's additional outlays for breast-cancer screening totaled about $350 million over the span from 2003 to 2008, according to the center's sampling of Medicare data, adding to the budgetary pressure on a program that needs to shed costs to survive.

The rise of digital mammography is a tale of intense industry marketing, direct-to-consumer advertising, political lobbying, and strategic campaign donations to politicians who forced Medicare to pay more for digital mammograms than for film mammograms, creating the financial incentive for clinics and hospitals to replace film machines with digital ones.

GE says digital mammography has taken off because it's the better way to go. "The faster, more streamlined, and more efficient you can make the exam experience for patients," says GE spokeswoman Allison Cohen, "the more likely you are to get the screening, which leads to earlier diagnosis, which leads to survival."

In the mid-1990s, when imaging manufacturers began making their pitch to the Food and Drug Administration, breast-cancer advocates and scientists hoped the new technology would let radiologists identify cancers that remained invisible in film mammograms, improving early detection. …