Are we able to balance the costs with the benefits-Breast Cancer Treatment

billionsStudy by authors Mei-Sing Ong and Kenneth Mandl : They say their findings indicate that the cost of breast cancer overtreatment appears to be much higher than previously estimated and around-  $4 billion and includes cost false-positive mammograms and breast cancer over diagnosis. Some Thoughts

Sharpening a medical debate about the costs and benefits of cancer screening, a new report estimates that the U.S. spends $4 billion a year on unnecessary medical costs due to mammograms that generate false alarms, and on treatment of certain breast tumors unlikely to cause problems.

The study published Monday in the journal Health Affairs breaks the cost down as follows: $2.8 billion resulting from false-positive mammograms and another $1.2 billion attributed to breast cancer overdiagnosis. That’s the treatment of tumors that grow slowly or not at all, and are unlikely to develop into life-threatening disease during a woman’s lifetime. The cost estimates cover women ages 40-59.

Breast cancer screening is a way in which doctors check the breasts for early signs of cancer in women who have no symptoms of breast cancer. The main test used to screen for breast cancer is a special kind of X-ray called a mammogram. This is usually combined with regular breast exams done by the doctor or nurse.

The goal of breast cancer screening is to find cancer early, before it has a chance to grow, spread, or cause problems. Studies show that being screened for breast cancer lowers the chance that a woman will die of the disease.

Experts recommend screening for most women age 50 to 70, and for some older women who are healthy. (Screening should involve mammograms, as well as breast exams done by a doctor or nurse.) Some women age 40 to 49 should also be screened. For instance, women who are at high risk of breast cancer sometimes need to begin screening at a young age. This might include women who:

Carry genes that increase their risk of breast cancer, such as the “BRCA” genes

Have close relatives who got breast cancer at a young age

You should talk with your doctor or nurse to decide when you should start screening.

Abnormal lump — Breast cancer can be discovered when a lump or other change in the breast or armpit is found by a woman herself or by her healthcare provider. In addition to a lump, other abnormal changes may include dimpling of the skin, a change in the size or shape of one breast, inversion (pulling in) of the nipple when it previously pointed outward, or a discoloration of the skin of the breast.

To evaluate a breast lump, a mammogram and a breast ultrasound are usually recommended. A breast biopsy may also be recommended . A suspicious lump should never be ignored, even if a mammogram is negative. Up to 20 percent of new breast cancers are not visible on a mammogram.

Mammogram — A mammogram is a low-dose x-ray of the breast. The breast tissue is compressed for the x-ray, which decreases the thickness of the tissue and holds the breast in position, so the radiologist can find abnormalities more accurately. Each breast is compressed between 2 panels and x-rayed from two directions (top-down and side-to-side) to make sure all the tissue is examined. Mammograms are currently the best screening modality to detect breast cancer.

Breast cancer is often diagnosed with a routine mammogram, before a lump or other change in the breast develops. Even if the mammogram is performed because a lump was felt in one breast, both breasts need to be examined because there is a small risk of having cancer in both breasts.

Breast ultrasound — An ultrasound uses sound waves to look at breast tissue and can tell if a lump is a fluid filled cyst or a solid lump. An ultrasound is only used to examine a limited area of the breast and is not used as a screening test of the entire breast.

Breast MRI — Magnetic resonance imaging (MRI) uses a strong magnet to create a detailed image of a part of the body. It does not use x-rays or radiation, but does require injection of a contrast agent into a vein. Breast MRI may be recommended to aid in the diagnosis of breast cancer in selected situations. MRI is not recommended to detect breast cancer in most women because it is not as good as a mammogram for certain breast conditions, such as ductal carcinoma in situ (a type of noninvasive or early breast cancer). In addition MRI testing is more likely to identify suspicious findings that turn out not to be cancer (false positives).

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